,,ii ,cal5d> ,no4 #djh #aac? ,,congress #b;d ,session ,s4 #bdbb ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,june #c1 #bjad ,mr4 ,s&]s 7= himself1 ,mr4 ,rockefell]1 ,mr4 ,begi*1 ,mrs4 ,%ahe51 ,mr4 ,ka9e1 ,mr4 ,re$1 ,mr4 ,m]kley1 ,mr4 ,casey1 ,mr4 ,:iteh\se1 ,mr4 ,blum5?al1 ,mr4 ,he9ri*1 ,mr4 ,udall ( ,new ,mexico1 ,mr4 ,s*atz1 ,ms4 ,baldw91 ,mr4 ,wyd51 ,mr4 ,leahy1 ,mr4 ,br[n1 ,ms4 ,heitkamp1 ,ms4 ,l&rieu1 ,mr4 ,book]1 ,mr4 ,durb91 ,mr4 ,s*um]1 ,ms4 ,hirono1 ,mr4 ,h>k91 ,mr4 ,coons1 ,mr4 ,m>key1 ,ms4 ,klobu*>1 ,mr4 ,wal%1 ,mr4 ,te/]1 & ,mr4 ,m55dez7 introduc$ ! foll[+ bill2 :i* 0 read ! fir/ "t ,june #d1 #bjad,read ! second "t & plac$ on ! cal5d> ,a ,,bill ,to improve ! access ( vet]ans to m$ical s]vices f ! ,dep>tm5t ( ,vet]ans ,affairs1 & = o!r purposes4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,ensur+ ,vet]ans ,access to ,c>e ,act ( #bjad4 7b7 ,table ( cont5ts ,! table ( cont5ts = ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4 ,,title ,i--,improvem5t ( ,s*$ul+ ,sy/em = ,heal? ,c>e ,appo9tm5ts ,sec4 #aja4 ,implem5tation ( upgrad$ ,dep>tm5t ( ,vet]ans ,affairs electronic s*$ul+ sy/em = appo9tm5ts = receipt ( heal? c>e f ! ,dep>tm5t4 ,sec4 #ajb4 ,indep5d5t assessm5t ( ! s*$ul+ process = m$ical appo9tm5ts = c>e f ,dep>tm5t ( ,vet]ans ,affairs4 ,,title ,,ii--,tra9+ & ,hir+ ( ,heal? ,c>e ,/aff ,sec4 #bja4 ,modification ( liability = brea* ( p]iod ( obligat$ s]vice "u ,heal? ,pr(essionals ,educational ,assi/ance ,program = prim>y c>e physicians4 ,sec4 #bjb4 ,program ( education at ,uni=m$ ,s]vices ,univ]sity ( ! ,heal? ,sci5ces ) specialization 9 prim>y c>e4 ,sec4 #bjc4 ,treatm5t ( /aff+ %ortage & biannual report on /aff+ ( m$ical facilities ( ! ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #bjd4 ,cl9ic managem5t tra9+ program ( ! ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #bje4 ,inclusion ( ,dep>tm5t ( ,vet]ans ,affairs facilities 9 ,national ,heal? ,s]vice ,corps ,s*ol>%ip & loan repaym5t programs4 ,sec4 #bjf4 ,au?orization ( em]g5cy appropriations4 ,,title ,,iii--,improvem5t ( ,access to ,c>e f ,non-,dep>tm5t ( ,vet]ans ,affairs ,provid]s ,sec4 #cja4 ,improvem5t ( access by vet]ans to heal? c>e f non-,dep>tm5t ( ,vet]ans ,affairs provid]s4 ,sec4 #cjb4 ,ext5sion ( & report on jo9t inc5tives program ( ,dep>tm5t ( ,vet]ans ,affairs & ,dep>tm5t ( ,def5se4 ,sec4 #cjc4 ,transf] ( au?ority = paym5ts = hospital c>e1 m$ical s]vices1 & o!r heal? c>e f non-,dep>tm5t provid]s to ! ,*ief ,bus9ess ,(fice ( ! ,vet]ans ,heal? ,adm9i/ration ( ! ,dep>tm5t4 ,sec4 #cjd4 ,enhancem5t ( collaboration betwe5 ,dep>tm5t ( ,vet]ans ,affairs & ,indian ,heal? ,s]vice4 ,sec4 #cje4 ,enhancem5t ( collaboration betwe5 ,dep>tm5t ( ,vet]ans ,affairs & ,native ,hawaiian heal? c>e sy/ems4 ,sec4 #cjf4 ,au?orization ( em]g5cy appropriations4 ,,title ,,iv--,heal? ,c>e ,adm9i/rative ,matt]s ,sec4 #dja4 ,improvem5t ( access ( vet]ans to mobile vet c5t]s ( ! ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #djb4 ,commission on ,access to ,c>e4 ,sec4 #djc4 ,commission on ,capital ,plann+ = ,dep>tm5t ( ,vet]ans ,affairs ,m$ical ,facilities4 ,sec4 #djd4 ,removal ( ,s5ior ,executive ,s]vice employees ( ! ,dep>tm5t ( ,vet]ans ,affairs = p]=mance4 ,,title ,v--,major ,m$ical ,facility ,leases ,sec4 #eja4 ,au?orization ( major m$ical facility leases4 ,sec4 #ejb4 ,budget>y treatm5t ( ,dep>tm5t ( ,vet]ans ,affairs major m$ical facilities leases4 ,i ,improvem5t ( ,s*$ul+ ,sy/em = ,heal? ,c>e ,appo9tm5ts #aja4 ,implem5tation ( upgrad$ ,dep>tm5t ( ,vet]ans ,affairs electronic s*$ul+ sy/em = appo9tm5ts = receipt ( heal? c>e f ! ,dep>tm5t 7a7 ,implem5tation 7#a7 ,9 g5]al ,n lat] ?an ,m>* #ca1 #bjaf1 ! ,secret>y ( ,vet]ans ,affairs %all fully implem5t an upgrad$ & c5traliz$ electronic s*$ul+ sy/em describ$ 9 subsection 7b7 = appo9tm5ts by eligible individuals = heal? c>e f ! ,dep>tm5t ( ,vet]ans ,affairs4 7#b7 ,agile s(tw>e developm5t me?odologies ,9 implem5t+ ! upgrad$ electronic s*$ul+ sy/em requir$ by p>agraph 7#a71 ! ,secret>y %all use agile s(tw>e developm5t me?odologies to fully implem5t portions ( su* sy/em e #ahj days beg9n+ on ! date on :i* ! ,secret>y beg9s ! implem5tation ( su* sy/em1 or ent]s into a contract = ! implem5tation ( su* sy/em1 & end+ on ! date on :i* su* sy/em is fully implem5t$4 7b7 ,electronic s*$ul+ sy/em ,! upgrad$ electronic s*$ul+ sy/em describ$ 9 ?is subsection %all include me*anisms to a*ieve ! foll[+3 7#a7 ,an effici5t & effective graphical us] int]face ) a cal5d> view = use by employees ( ! ,dep>tm5t 9 s*$ul+ appo9tm5ts t enables error-free s*$ul+ ( ! heal? c>e res\rces ( ! ,dep>tm5t4 7#b7 ,a capability to assi/ employees ( ! ,dep>tm5t to easily & consi/5tly implem5t policies ( ! ,dep>tm5t ) respect to s*$ul+ ( appo9tm5ts1 includ+ ) respect to priority = appo9tm5ts = c]ta9 eligible individuals4 7#c7 ,a capability = employees ( ! ,dep>tm5t to sort & view ?r\gh a unifi$ int]face ! availability = ea* heal? c>e provid] ( ! ,dep>tm5t or o!r heal? c>e res\rce ( ! ,dep>tm5t4 7#d7 ,a capability = employees ( ! ,dep>tm5t to sort & view appo9tm5ts = & appo9tm5t reque/s made by a p>ticul> eligible individual4 7#e7 ,a capability = seamless coord9ation ( appo9tm5ts = prim>y c>e1 specialty c>e1 consultations1 or any o!r heal? c>e matt] among facilities ( ! ,dep>tm5t4 7#f7 ,a capability = eligible individuals to access ! sy/em remotely & s*$ule appo9tm5ts directly ?r\gh ! sy/em4 7#g7 ,an electronic time/amp ( ea* activity made by an eligible individual or on behalf ( su* individual ) respect to an appo9tm5t or ! s*$ul+ ( an appo9tm5t t %all be kept 9 ! m$ical record ( su* individual4 7#h7 ,a seamless connection to ! ,comput]iz$ ,pati5t ,record ,sy/em ( ! ,dep>tm5t s t employees ( ! ,dep>tm5t1 :5 s*$ul+ an appo9tm5t = an eligible individual1 h access to recomm5dations f ! heal? c>e provid] ( su* individual ) respect to :5 su* individual %\ld receive an appo9tm5t4 7#i7 ,a capability to provide automat$ rem9d]s to eligible individuals on upcom+ appo9tm5ts ?r\gh v>i\s electronic & voice m$ia4 7#aj7 ,a capability to provide automat$ rem9d]s to employees ( ! ,dep>tm5t :5 an eligible individual :o is on ! wait-li/ = an appo9tm5t becomes eligible to s*$ule an appo9tm5t4 7#aa7 ,a da%bo>d capability to support ef=ts to track ! foll[+ metrics 9 aggregate & by m$ical facility ) respect to heal? c>e provid$ to eligible individuals "u ! laws adm9i/]$ by ! ,secret>y3 7,a7 ,! numb] ( days into ! future t ! s*$ules ( heal? c>e provid]s are available to s*$ule an appo9tm5t4 7,b7 ,! numb] ( provid]s available to see pati5ts ea* day4 7,c7 ,! numb] ( support p]sonnel work+ ea* day4 7,d7 ,! types ( appo9tm5ts available4 7,e7 ,! rate at :i* pati5ts fail to appe> = appo9tm5ts4 7,f7 ,! numb] ( appo9tm5ts cancel$ by a pati5t on a daily basis4 7,g7 ,! numb] ( appo9tm5ts cancel$ by a heal? c>e provid] on a daily basis4 7,h7 ,! numb] ( pati5ts on ! wait li/ at any giv5 "t4 7,i7 ,! numb] ( appo9tm5ts s*$ul$ on a daily basis2 7,j7 ,! numb] ( appo9tm5ts available to be s*$ul$ on a daily basis4 7,k7 ,! numb] ( pati5ts se5 on a daily1 weekly1 & mon?ly basis4 7,l7 ,wait-times = an appo9tm5t ) a heal? c>e provid] ( ! ,dep>tm5t4 7,m7 ,wait-times = an appo9tm5t ) a non-,dep>tm5t heal? c>e provid]4 7,n7 ,wait-times = a ref]ral to a speciali/ or consult4 7#ab7 ,a capability to provide data on ! capacity ( m$ical facilities ( ! ,dep>tm5t = purposes ( det]m9+ ! res\rces ne$$ by ! ,dep>tm5t to provide heal? c>e to eligible individuals4 7#ac7 ,any o!r capabilities z specifi$ by ! ,secret>y = purposes ( ?is section4 7c7 ,plan 7#a7 ,9 g5]al ,n lat] ?an #ij days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a plan = implem5t+ ! upgrad$ electronic s*$ul+ sy/em requir$ by subsection 7a74 7#b7 ,elem5ts ,! plan requir$ by p>agraph 7#a7 %all include ! foll[+3 7,a7 ,a description ( ! priorities ( ! ,secret>y = implem5t+ ! requirem5ts ( ! sy/em "u subsection 7b74 7,b7 ,a detail$ description ( ! mann] 9 :i* ! ,secret>y w fully implem5t su* sy/em1 includ+ deadl9es = complet+ ea* su* requirem5t4 7#c7 ,update ,n lat] ?an #ij days aft] ! submittal ( ! plan requir$ by p>agraph 7#a71 & n less frequ5tly ?an e #ij days !reaft] until su* sy/em is fully implem5t$1 ! ,secret>y %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives an update on ! /atus ( ! implem5tation ( su* plan4 7d7 ,use ( am\nts ,! ,secret>y may use am\nts available to ! ,dep>tm5t ( ,vet]ans ,affairs = ! appropriations acc\nt "u ! head+ ,m$ical ,s]vices 9 implem5t+ & c>ry+ out ! upgrad$ electronic s*$ul+ sy/em requir$ by subsection 7a74 7e7 ,eligible individual def9$ ,9 ?is section1 ! t]m eligible individual means an individual eligible = hospital1 nurs+ home1 domicili>y1 m$ical c>e1 or o!r heal? c>e "u ! laws adm9i/]$ by ! ,secret>y ( ,vet]ans ,affairs4 #ajb4 ,indep5d5t assessm5t ( ! s*$ul+ process = m$ical appo9tm5ts = c>e f ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,indep5d5t assessm5t 7#a7 ,contract ,n lat] ?an #cj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]an ,affairs %all ent] into a contract ) an indep5d5t ?ird p>ty to assess ! process at ea* m$ical facility ( ! ,dep>tm5t ( ,vet]ans ,affairs = s*$ul+ appo9tm5ts = vet]ans to receive hospital c>e1 m$ical s]vices1 or o!r heal? c>e f ! ,dep>tm5t4 7#b7 ,elem5ts ,9 c>ry+ out ! assessm5t requir$ by p>agraph 7#a71 ! indep5d5t ?ird p>ty %all d ! foll[+3 7,a7 ,review all tra9+ mat]ials p]ta9+ to s*$ul+ ( appo9tm5ts at ea* m$ical facility ( ! ,dep>tm5t4 7,b7 ,assess :e!r all employees ( ! ,dep>tm5t conduct+ tasks relat$ to s*$ul+ are prop]ly tra9$ = conduct+ su* tasks4 7,c7 ,assess :e!r *anges 9 ! te*nology or sy/em us$ 9 s*$ul+ appo9tm5ts are necess>y to limit access to ! sy/em to only ^? employees t h be5 prop]ly tra9$ 9 conduct+ su* tasks4 7,d7 ,assess :e!r heal? c>e provid]s ( ! ,dep>tm5t are mak+ *anges to _! s*$ules t h9d] ! ability ( employees conduct+ su* tasks to p]=m su* tasks4 7,e7 ,assess :e!r ! e/abli%m5t ( a c5traliz$ call c5t] ?r\gh\t ! ,dep>tm5t = s*$ul+ appo9tm5ts at m$ical facilities ( ! ,dep>tm5t w\ld improve ! process ( s*$ul+ su* appo9tm5ts4 7,f7 ,assess :e!r book+ templates = ea* m$ical facility or cl9ic ( ! ,dep>tm5t w\ld improve ! process ( s*$ul+ su* appo9tm5ts4 7,g7 ,recomm5d any actions to be tak5 by ! ,dep>tm5t to improve ! process = s*$ul+ su* appo9tm5ts1 includ+ ! foll[+3 7i7 ,*anges 9 tra9+ mat]ials provid$ to employees ( ! ,dep>tm5t ) respect to conduct+ tasks relat$ to s*$ul+ su* appo9tm5ts4 7ii7 ,*anges 9 monitor+ & assessm5t conduct$ by ! ,dep>tm5t ( wait-times ( vet]ans = su* appo9tm5ts4 7iii7 ,*anges 9 ! sy/em us$ to s*$ule su* appo9tm5ts1 includ+ *anges to improve h[ ! ,dep>tm5t-- 7,i7 measures wait-times ( vet]ans = su* appo9tm5ts2 7,,ii7 monitors ! availability ( heal? c>e provid]s ( ! ,dep>tm5t2 & 7,,iii7 provides vet]ans ! ability to s*$ule su* appo9tm5ts4 7iv7 ,su* o!r actions z ! indep5d5t ?ird p>ty consid]s appropriate4 7#c7 ,tim+ ,! indep5d5t ?ird p>ty c>ry+ out ! assessm5t requir$ by p>agraph 7#a7 %all complete su* assessm5t n lat] ?an #ahj days aft] ent]+ into ! contract describ$ 9 su* p>agraph4 7b7 ,report ,n lat] ?an #ij days aft] ! date on :i* ! indep5d5t ?ird p>ty completes ! assessm5t "u ?is section1 ! ,secret>y %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report on ! results ( su* assessm5t4 ,,ii ,tra9+ & ,hir+ ( ,heal? ,c>e ,/aff #bja4 ,modification ( liability = brea* ( p]iod ( obligat$ s]vice "u ,heal? ,pr(essionals ,educational ,assi/ance ,program = prim>y c>e physicians ,section #gfag ( title #ch1 ,unit$ ,/ates ,code1 is am5d$-- 7#a7 ,9 subsection 7c77#a71 by /rik+ ,if a p>ticipant & ins]t+ ,except z provid$ 9 subsection 7d71 if a p>ticipant2 & 7#b7 by add+ at ! end ! foll[+ new subsection3 7d7 ,liability %all n arise "u subsection 7c7 9 ! case ( a p>ticipant o!rwise cov]$ by t subsection :o has pursu$ a c\rse ( education or tra9+ 9 prim>y c>e if-- 7#a7 ! p>ticipant-- 7,a7 does n obta91 or fails to ma9ta91 employm5t z a ,dep>tm5t employee due to /aff+ *anges approv$ by ! ,"u ,secret>y = ,heal?2 or 7,b7 does n obta91 or fails to ma9ta91 employm5t 9 a position ( prim>y c>e physician 9 ! ,vet]ans ,heal? ,adm9i/ration due1 z det]m9$ by ! ,secret>y1 to a numb] ( prim>y c>e physicians 9 ! ,adm9i/ration t is excess to ! ne$s ( ! ,adm9i/ration2 & 7#b7 ! p>ticipant agrees to accept & ma9ta9 employm5t z a prim>y c>e physician ) ano!r dep>tm5t or ag5cy ( ! ,f$]al ,gov]nm5t 7) su* employm5t to be "u su* t]ms & conditions z are jo9tly agre$ ^u by ! p>ticipant1 ! ,secret>y1 & ! head ( su* dep>tm5t or ag5cy1 includ+ t]ms & conditions relat+ to a p]iod ( obligat$ s]vice z a prim>y c>e physician ) su* dep>tm5t or ag5cy7 if su* employm5t is (f]$ to ! p>ticipant by ! ,secret>y & ! head ( su* dep>tm5t or ag5cy4 4 #bjb4 ,program ( education at ,uni=m$ ,s]vices ,univ]sity ( ! ,heal? ,sci5ces ) specialization 9 prim>y c>e 7a7 ,program requir$ "u ,heal? ,pr(essionals ,educational ,assi/ance ,program 7#a7 ,9 g5]al ,*apt] #gf ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by add+ aft] sub*apt] ,,vii ! foll[+ new sub*apt]3 ,,viii ,program ( ,education at ,uni=m$ ,s]vices ,univ]sity ( ! ,heal? ,sci5ces ,) ,specialization 9 ,prim>y ,c>e #gfia4 ,au?ority = program ,z "p ( ! ,educational ,assi/ance ,program1 ! ,secret>y %all1 9 collaboration ) ! ,secret>y ( ,def5se1 c>ry out a program to p]mit individuals to enroll 9 ! ,uni=m$ ,s]vices ,univ]sity ( ! ,heal? ,sci5ces "u *apt] #ajd ( title #aj to pursue a m$ical education ) a specialization 9 prim>y c>e4 ,! program %all be kn[n z ! ,dep>tm5t ( ,vet]ans ,affairs ,prim>y ,c>e ,educational ,assi/ance ,program 79 ?is *apt] ref]r$ to z ! ,prim>y ,c>e ,educational ,assi/ance ,program74 #gfib4 ,selection2 agreem5t2 ineligibility = c]ta9 o!r educational assi/ance 7a7 ,selection 7#a7 ,m$ical /ud5ts at ! ,uni=m$ ,s]vices ,univ]sity ( ! ,heal? ,sci5ces pursuant to ! ,prim>y ,c>e ,educational ,assi/ance ,program %all be select$ by ! ,secret>y1 9 consultation ) ! ,secret>y ( ,def5se1 9 accordance ) proc$ures e/abli%$ by ! ,secret>ies = purposes ( ! ,program4 7#b7 ,! proc$ures ref]r$ to 9 p>agraph 7#a7 %all emphasize ! basic requirem5t t /ud5ts demon/rate a motivation & d$ication to a m$ical c>e] 9 prim>y c>e4 7#c7 ,! numb] ( m$ical /ud5ts select$ ea* ye> = fir/-ye> enrollm5t 9 ! ,univ]sity pursuant to ?is subsection %all be jo9tly det]m9$ by ! ,secret>y & ! ,secret>y ( ,def5se4 7b7 ,agreem5t ,an agreem5t betwe5 ! ,secret>y & a p>ticipant 9 ! ,prim>y ,c>e ,educational ,assi/ance ,program %all 79 addition to ! requirem5ts set =? 9 section #gfjd ( ?is title7 include ! foll[+3 7#a7 ,! ,secret>y's agreem5t to cov] ! co/s ( ! p>ticipant's education & tra9+ at ! ,uni=m$ ,s]vices ,univ]sity ( ! ,heal? ,sci5ces "u *apt] #ajd ( title #aj z if ! p>ticipant 7 a m$ical /ud5t enroll$ 9 ! ,univ]sity pursuant to section #baad ( title #aj4 7#b7 ,! p>ticipant's agreem5t to s]ve z a full-"t employee 9 ! ,vet]ans ,heal? ,adm9i/ration 9 a position z a prim>y c>e physician = a p]iod ( "t 79 ?is sub*apt] ref]r$ to z ! p]iod ( obligat$ s]vice7 ( "o cal5d> ye> = ea* s*ool ye> or "p !re( = :i* ! p>ticipant 0 a m$ical /ud5t at ! ,uni=m$ ,s]vices ,univ]sity ( ! ,heal? ,sci5ces pursuant to ! ,prim>y ,c>e ,educational ,assi/ance ,program1 b = n less ?an "o ye>4 7c7 ,ineligibility = o!r educational assi/ance ,an individual :o receives education & tra9+ "u ! ,prim>y ,c>e ,educational ,assi/ance ,program %all n be eligible = o!r assi/ance "u ?is *apt] 9 connection ) su* education & tra9+4 #gfic4 ,obligat$ s]vice 7a7 ,9 g5]al ,ea* p>ticipant 9 ! ,prim>y ,c>e ,educational ,assi/ance ,program %all provide s]vice z a full-"t employee ( ! ,dep>tm5t 9 ! ,vet]ans ,heal? ,adm9i/ration 9 a prim>y c>e position = ! p]iod ( obligat$ s]vice provid$ 9 ! agreem5t ( ! p>ticipant ent]$ into = purposes ( ?is sub*apt]4 ,su* s]vice %all be provid$ 9 a full-"t prim>y c>e cl9ical practice 9 an assignm5t or location det]m9$ by ! ,secret>y4 7b7 ,s]vice comm5cem5t date 7#a7 ,n lat] ?an #fj days be=e a p>ticipant's s]vice comm5cem5t date1 ! ,secret>y %all notify ! p>ticipant ( t s]vice comm5cem5t date4 ,t date is ! date = ! beg9n+ ( ! p>ticipant's p]iod ( obligat$ s]vice4 7#b7 ,z soon z possible aft] a p>ticipant's s]vice comm5cem5t date1 ! ,secret>y %all-- 7,a7 9 ! case ( a p>ticipant :o is n a full-"t employee 9 ! ,vet]ans ,heal? ,adm9i/ration1 appo9t ! p>ticipant z su* an employee2 & 7,b7 9 ! case ( a p>ticipant :o is an employee 9 ! ,vet]ans ,heal? ,adm9i/ration b is n s]v+ 9 a position = :i* ! p>ticipant's c\rse ( education or tra9+ prep>$ ! p>ticipant1 assign ! p>ticipant to su* a position4 7#c7 ,a p>ticipant's s]vice comm5cem5t = purposes ( ?is subsection date is ! date ^u :i* ! p>ticipant becomes lic5s$ to practice m$ic9e 9 a ,/ate4 7c7 ,comm5cem5t ( obligat$ s]vice ,a p>ticipant 9 ! ,prim>y ,c>e ,educational ,assi/ance ,program %all be consid]$ to h begun s]v+ ! p>ticipant's p]iod ( obligat$ s]vice-- 7#a7 on ! date on :i* ! p>ticipant is appo9t$ z a full-"t employee 9 ! ,vet]ans ,heal? ,adm9i/ration pursuant to subsection 7b77#b77;,a72 or 7#b7 if ! p>ticipant is a full-"t employee 9 ! ,vet]ans ,heal? ,adm9i/ration & assign$ to a position pursuant to subsection 7b77#b77;,b71 on ! date on :i* ! p>ticipant is s assign$ to su* position4 #gfid4 ,brea* ( agreem5t3 liability 7a7 ,liability dur+ c\rse ( education or tra9+ 7#a7 ,a p>ticipant 9 ! ,prim>y ,c>e ,educational ,assi/ance ,program %all be liable to ! ,unit$ ,/ates = ! am\nt :i* has be5 paid on behalf ( ! p>ticipant "u ! agreem5t ent]$ into = purposes ( ?is sub*apt] if any ( ! foll[+ occurs3 7,a7 ,! p>ticipant fails to ma9ta9 an acceptable level ( academic /&+ 9 ! ,uni=m$ ,s]vices ,univ]sity ( ! ,heal? ,sci5ces4 7,b7 ,! p>ticipant is dismiss$ f ! ,uni=m$ ,s]vices ,univ]sity ( ! ,heal? ,sci5ces = discipl9>y reasons4 7,c7 ,! p>ticipant volunt>ily t]m9ates ! c\rse ( m$ical education & tra9+ 9 ! ,uni=m$ ,s]vices ,univ]sity ( ! ,heal? ,sci5ces be=e ! completion ( su* c\rse ( education & tra9+4 7,d7 ,! p>ticipant fails to become lic5s$ to practice m$ic9e 9 a ,/ate dur+ a p]iod ( "t det]m9$ "u regulations prescrib$ by ! ,secret>y4 7#b7 ,liability "u ?is subsection is 9 lieu ( any s]vice obligation aris+ "u a p>ticipant's agreem5t = purposes ( ?is sub*apt]4 7b7 ,liability dur+ p]iod ( obligat$ s]vice 7#a7 ,except z provid$ 9 subsection 7c7 & subject to p>agraph 7#b71 if a p>ticipant 9 ! ,prim>y ,c>e ,educational ,assi/ance ,program brea*es ! agreem5t ent]$ into = purposes ( ?is sub*apt] by fail+ = any reason to complete ! p>ticipant's p]iod ( obligat$ s]vice1 ! ,unit$ ,/ates %all be entitl$ to recov] f ! p>ticipant an am\nt equal to-- 7,a7 ! total am\nt paid "u ?is sub*apt] on behalf ( ! p>ticipant2 multipli$ by 7,b7 a fraction-- 7i7 ! num]ator ( :i* is-- 7,i7 ! total numb] ( mon?s 9 ! p>ticipant's p]iod ( obligat$ s]vice2 m9us 7,,ii7 ! numb] ( mon?s s]v$ by ! p>ticipant pursuant to ! agreem5t2 & 7ii7 ! d5om9ator ( :i* is ! total numb] ( mon?s 9 ! p>ticipant's p]iod ( obligat$ s]vice4 7#b7 ,any p]iod ( int]n%ip or resid5cy tra9+ ( a p>ticipant %all n be treat$ z satisfy+ ! p>ticipant's p]iod ( obligat$ s]vice = purposes ( ?is subsection4 7c7 ,exceptions ,liability %all n arise "u subsection 7b7 9 ! case ( a p>ticipant o!rwise cov]$ by t subsection if-- 7#a7 ! p>ticipant-- 7,a7 does n obta91 or fails to ma9ta91 employm5t z a ,dep>tm5t employee due to /aff+ *anges approv$ by ! ,"u ,secret>y = ,heal?2 or 7,b7 does n obta91 or fails to ma9ta91 employm5t 9 a position ( prim>y c>e physician 9 ! ,vet]ans ,heal? ,adm9i/ration due1 z det]m9$ by ! ,secret>y1 to a numb] ( prim>y c>e physicians 9 ! ,adm9i/ration t is excess to ! ne$s ( ! ,adm9i/ration2 & 7#b7 ! p>ticipant agrees to accept & ma9ta9 employm5t z a prim>y c>e physician ) ano!r dep>tm5t or ag5cy ( ! ,f$]al ,gov]nm5t 7) su* employm5t to be "u su* t]ms & conditions z are jo9tly agre$ ^u by ! p>ticipant1 ! ,secret>y1 & ! head ( su* dep>tm5t or ag5cy1 includ+ t]ms & conditions relat+ to a p]iod ( obligat$ s]vice z a prim>y c>e physician ) su* dep>tm5t or ag5cy7 if su* employm5t is (f]$ to ! p>ticipant by ! ,secret>y & ! head ( su* dep>tm5t or ag5cy4 #gfie4 ,fund+ 7a7 ,9 g5]al ,am\nts = ! ,prim>y ,c>e ,educational ,assi/ance ,program %all be d]iv$ f am\nts available to ! ,secret>y = ! ,vet]ans ,heal? ,adm9i/ration4 7b7 ,transf] 7#a7 ,! ,secret>y %all transf] to ! ,secret>y ( ,def5se am\nts requir$ by ! ,secret>y ( ,def5se to c>ry out ! ,prim>y ,c>e ,educational ,assi/ance ,program4 7#b7 ,am\nts transf]r$ to ! ,secret>y ( ,def5se pursuant to p>agraph 7#a7 %all be cr$it$ to ! appropriation or acc\nt provid+ fund+ = ! ,uni=m$ ,s]vices ,univ]sity ( ! ,heal? ,sci5ces4 ,am\nts s cr$it$ %all be m]g$ ) am\nts 9 ! appropriation or acc\nt to :i* cr$it$ & %all be available1 subject to ! t]ms & conditions applicable to su* appropriation or acc\nt1 = ! ,uni=m$ ,s]vices ,univ]sity ( ! ,heal? ,sci5ces4 4 7#b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #gf ( su* title is am5d$ by add+ aft] ! item relat+ to section #gfhd ! foll[+3 ,,sub*apt] ,,viii--,program ( ,education at ,uni=m$ ,s]vices ,univ]sity ( ! ,heal? ,sci5ces ,) ,specialization 9 ,prim>y ,c>e #gfia4 ,au?ority = program4 #gfib4 ,selection2 agreem5t2 ineligibility = c]ta9 o!r educational assi/ance4 #gfic4 ,obligat$ s]vice4 #gfid4 ,brea* ( agreem5t3 liability4 #gfie4 ,fund+4 4 7b7 ,inclusion ( program 9 ,heal? ,pr(essionals ,educational ,assi/ance ,program ,section #gfja7;a7 ( su* title is am5d$-- 7#a7 9 p>agraph 7#d71 by /rik+ 2 & & ins]t+ a semicolon2 7#b7 9 p>agraph 7#e71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7#c7 by add+ at ! end ! foll[+ new p>agraph3 7#f7 ! enrollm5t ( individuals 9 ! ,uni=m$ ,s]vices ,univ]sity ( ! ,heal? ,sci5ces = specialization 9 prim>y c>e provid$ = 9 sub*apt] ,,viii ( ?is *apt]4 4 7c7 ,application requirem5ts 7#a7 ,9 g5]al ,subsection 7a77#a7 ( section #gfjc ( su* title is am5d$ 9 ! matt] prec$+ subp>agraph 7,a7 by /rik+ 1 or ,,vi & ins]t+ 1 ,,vi1 or ,,viii4 7#b7 ,no priority = applications ,subsection 7d7 ( su* section is am5d$-- 7,a7 by /rik+ ,9 select+ & ins]t+ 7#a7 ,except z provid$ 9 p>agraph 7#b71 9 select+2 & 7,b7 by add+ at ! end ! foll[+ new p>agraph3 7#b7 ,p>agraph 7#a7 %all n apply ) respect to applicants = p>ticipation 9 ! ,program ( ,education at ,uni=m$ ,s]vices ,univ]sity ( ! ,heal? ,sci5ces ,) ,specialization 9 ,prim>y ,c>e pursuant to sub*apt] ,,viii ( ?is *apt]4 4 7d7 ,agreem5t requirem5ts ,section #gfjd ( su* title is am5d$ by /rik+ 1 or ,,vi ea* place x appe>s & ins]t+ 1 ,,vi1 or ,,viii4 #bjc4 ,treatm5t ( /aff+ %ortage & biannual report on /aff+ ( m$ical facilities ( ! ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,/aff+ %ortage 7#a7 ,9 g5]al ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 & n lat] ?an ,septemb] #cj ea* ye> !reaft]1 ! ,secret>y ( ,vet]ans ,affairs %all det]m9e1 & publi% 9 ! ,f$]al ,regi/]1 ! five occupations ( heal? c>e provid]s ( ! ,dep>tm5t ( ,vet]ans ,affairs = :i* !re is ! l>ge/ /aff+ %ortage ?r\gh\t ! ,dep>tm5t4 7#b7 ,recruitm5t & appo9tm5t ,not)/&+ sections #ccjd & #ccji ?r\gh #ccah ( title #e1 ,unit$ ,/ates ,code1 ! ,secret>y may1 ^u a det]m9ation by ! ,secret>y "u p>agraph 7#a7 or a modification to su* det]m9ation "u p>agraph 7#b71 t !re is a /aff+ %ortage ?r\gh\t ! ,dep>tm5t ) respect to a p>ticul> occupation ( heal? c>e provid]1 recruit & directly appo9t highly qualifi$ heal? c>e provid]s to a position to s]ve z a heal? c>e provid] 9 t p>ticul> occupation = ! ,dep>tm5t4 7#c7 ,priority 9 ,heal? ,pr(essionals ,educational ,assi/ance ,program to c]ta9 provid]s ,section #gfab7;b77#e7 ( title #ch1 ,unit$ ,/ates ,code1 is am5d$-- 7,a7 9 subp>agraph 7,a71 by /rik+ & at ! end2 7,b7 by r$esignat+ subp>agraph 7,b7 z subp>agraph 7,c72 & 7,c7 by ins]t+ aft] subp>agraph 7,a7 ! foll[+ new subp>agraph 7,b73 7,b7 %all give priority to applicants pursu+ a c\rse ( education or tra9+ t[>ds a c>e] 9 an occupation = :i* ! ,secret>y has1 9 ! mo/ curr5t det]m9ation publi%$ 9 ! ,f$]al ,regi/] pursuant to section #bjc7;a77#a7 ( ! ,ensur+ ,vet]ans ,access to ,c>e ,act ( #bjad1 det]m9$ t !re is "o ( ! l>ge/ /aff+ %ortage ?r\gh\t ! ,dep>tm5t ) respect to su* occupation2 & 4 7b7 ,reports 7#a7 ,9 g5]al ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 & n lat] ?an ,decemb] #ca ( ea* ev5 numb]$ ye> !reaft] until #bjbd1 ! ,secret>y ( ,vet]ans ,affairs %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report assess+ ! /aff+ ( ea* m$ical facility ( ! ,dep>tm5t ( ,vet]ans ,affairs4 7#b7 ,elem5ts ,ea* report submitt$ "u p>agraph 7#a7 %all include ! foll[+3 7,a7 ,! results ( a sy/em-wide assessm5t ( all m$ical facilities ( ! ,dep>tm5t to ensure ! foll[+3 7i7 ,appropriate /aff+ levels = heal? c>e provid]s to meet ! goals ( ! ,secret>y = timely access to c>e = vet]ans4 7ii7 ,appropriate /aff+ levels = support p]sonnel1 includ+ cl]ks4 7iii7 ,appropriate sizes = cl9ical panels4 7iv7 ,appropriate numb]s ( full-"t /aff1 or full-"t equival5t1 d$icat$ to direct c>e ( pati5ts4 7v7 ,appropriate physical plant space to meet ! capacity ne$s ( ! ,dep>tm5t 9 t area4 7vi7 ,su* o!r factors z ! ,secret>y consid]s necess>y4 7,b7 ,a plan = address+ any issues id5tifi$ 9 ! assessm5t describ$ 9 subp>agraph 7,a71 includ+ a timel9e = address+ su* issues4 7,c7 ,a li/ ( ! curr5t wait times & workload levels = ! foll[+ cl9ics 9 ea* m$ical facility3 7i7 ,m5tal heal?4 7ii7 ,prim>y c>e4 7iii7 ,ga/ro5t]ology4 7iv7 ,wom5's heal?4 7v7 ,su* o!r cl9ics z ! ,secret>y consid]s appropriate4 7,d7 ,a description ( ! results ( ! det]m9ation ( ! ,secret>y "u p>agraph 7#a7 ( subsection 7a7 & a plan to use direct appo9tm5t au?ority "u p>agraph 7#b7 ( su* subsection to fill /aff+ %ortages1 includ+ recomm5dations = improv+ ! spe$ at :i* ! cr$5tial+ & privileg+ process c be conduct$4 7,e7 ,! curr5t /aff+ models ( ! ,dep>tm5t = ! foll[+ cl9ics1 includ+ recomm5dations = *anges to su* models3 7i7 ,m5tal heal?4 7ii7 ,prim>y c>e4 7iii7 ,ga/ro5t]ology4 7iv7 ,wom5's heal?4 7v7 ,su* o!r cl9ics z ! ,secret>y consid]s appropriate4 7,f7 ,a detail$ analysis ( succession plann+ at m$ical facilities ( ! ,dep>tm5t1 includ+ ! foll[+3 7i7 ,! numb] ( positions 9 m$ical facilities ?r\gh\t ! ,dep>tm5t t are n fill$ by a p]man5t employee4 7ii7 ,! l5g? ( "t ea* su* position describ$ 9 clause 7i7 rema9$ vacant or fill$ by a tempor>y or act+ employee4 7iii7 ,a description ( any b>ri]s to fill+ ! positions describ$ 9 clause 7i74 7iv7 ,a plan = fill+ any positions t are vacant or fill$ by a tempor>y or act+ employee = m ?an #ahj days4 7v7 ,a plan = h&l+ em]g5cy circum/ances1 su* adm9i/rative leave or sudd5 m$ical leave = s5ior (ficials4 7,g7 ,! numb] ( heal? c>e provid]s :o h be5 remov$ f _! position or h retir$1 by provid] type1 dur+ ! two-ye> p]iod prec$+ ! submittal ( ! report4 7,h7 ,( ! heal? c>e provid]s specifi$ 9 subp>agraph 7,g7 t h be5 remov$ f _! position1 ! foll[+3 7i7 ,! numb] ( su* heal? c>e provid]s :o 7 reassign$ to ano!r position 9 ! ,dep>tm5t4 7ii7 ,! numb] ( su* heal? c>e provid]s :o left ! ,dep>tm5t4 #bjd4 ,cl9ic managem5t tra9+ program ( ! ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,9 g5]al ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all implem5t a cl9ic managem5t tra9+ program to provide 9-p]son1 /&>diz$ education on heal? c>e managem5t to all manag]s (1 & heal? c>e provid]s at1 m$ical facilities ( ! ,dep>tm5t ( ,vet]ans ,affairs4 7b7 ,elem5ts ,! cl9ic managem5t tra9+ program requir$ by subsection 7a7 %all include ! foll[+3 7#a7 ,tra9+ on h[ to manage ! s*$ules ( heal? c>e provid]s ( ! ,dep>tm5t1 includ+ ! foll[+3 7,a7 ,ma9ta9+ su* s*$ules 9 a mann] t all[s appo9tm5ts to be book$ at lea/ eight weeks 9 advance4 7,b7 ,prop] plann+ proc$ures = vacation1 leave1 & graduate m$ical education tra9+ s*$ules4 7#b7 ,tra9+ on ! appropriate numb] ( appo9tm5ts t a heal? c>e provid] %\ld conduct on a daily basis1 bas$ on specialty4 7#c7 ,tra9+ on h[ to det]m9e :e!r !re are en\gh available appo9tm5t slots to manage dem& = diff]5t appo9tm5t types & me*anisms = al]t+ managem5t ( insuffici5t slots4 7#d7 ,tra9+ on h[ to prop]ly use ! data produc$ by ! s*$ul+ da%bo>d requir$ by section #aja7;b77#aa7 ( ?is ,act to meet dem& = heal? c>e1 includ+ ! foll[+3 7,a7 ,tra9+ on det]m9+ ! next available appo9tm5t = ea* heal? c>e provid] at ! m$ical facility4 7,b7 ,tra9+ on det]m9+ ! numb] ( heal? c>e provid]s ne$$ to meet dem& = heal? c>e at ! m$ical facility4 7,c7 ,tra9+ on det]m9+ ! numb] ( exam rooms ne$$ to meet dem& = su* heal? c>e 9 an effici5t mann]4 7#e7 ,tra9+ on h[ to prop]ly use ! appo9tm5t s*$ul+ sy/em ( ! ,dep>tm5t1 includ+ any new s*$ul+ sy/em implem5t$ by ! ,dep>tm5t4 7#f7 ,tra9+ on h[ to optimize ! use ( te*nology1 includ+ ! foll[+3 7,a7 ,telem$ic9e4 7,b7 ,electronic mail4 7,c7 ,text messag+4 7,d7 ,su* o!r te*nologies z specifi$ by ! ,secret>y4 7#g7 ,tra9+ on h[ to prop]ly use physical plant space at m$ical facilities ( ! ,dep>tm5t to ensure effici5t fl[ & privacy = pati5ts & /aff4 #bje4 ,inclusion ( ,dep>tm5t ( ,vet]ans ,affairs facilities 9 ,national ,heal? ,s]vice ,corps ,s*ol>%ip & loan repaym5t programs 7a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices %all use ! funds transf]r$ "u subsection 7e7 to aw>d s*ol>%ip & loan repaym5t contracts "u sections #cch;,a & #cch;,b ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bedl1 #bedl-#a7 to eligible individuals :o agree to a p]iod ( obligat$ s]vice "u section #cch;,a7f77#a7 or #cch;,b7f77#a7 ( su* ,act1 z applicable1 at a heal? facility ( ! ,dep>tm5t ( ,vet]ans ,affairs4 7b7 ,heal? pr(essional %ortage areas ,= purposes ( select+ individuals eligible = ! s*ol>%ips & loan repaym5t contracts "u subsection 7a71 all heal? facilities ( ! ,dep>tm5t ( ,vet]ans ,affairs %all be deem$ heal? pr(essional %ortage areas1 z def9$ 9 section #ccb ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;e74 7c7 ,requirem5t ,! ,secret>y ( ,heal? & ,human ,s]vices %all ensure t a m9imum ( #e s*ol>%ips or loan repaym5t contracts are aw>d$ to individuals :o agree to a p]iod ( obligat$ s]vice at ,vet]ans ,affairs facilities 9 ea* ,/ate4 7d7 ,applicability ( ,,nhsc program requirem5ts ,except z o!rwise provid$ 9 ?is section1 ! t]ms ( ! ,national ,heal? ,s]vice ,corps ,s*ol>%ip ,program & ! ,national ,heal? ,s]vice ,corps ,loan ,repaym5t ,program %all apply to p>ticipants aw>d$ a grant or loan repaym5t contract "u subsection 7a7 9 ! same mann] t su* t]ms apply to p>ticipants aw>d$ a grant or loan repaym5t contract "u section #cch;,a or #cch;,b ( ! ,public ,heal? ,s]vice ,act4 7e7 ,inclusion ( g]iatricians ,= purposes ( aw>d+ s*ol>%ips & loan repaym5ts contracts to eligible individuals :o agree to a p]iod ( obligat$ s]vice at a heal? facility ( ! ,dep>tm5t ( ,vet]ans ,affairs pursuant to ?is section1 9 sections #cch;,a & #cch;,b ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bedl1 #bedl-#a71 ! t]m prim>y heal? s]vices %all include g]iatrics4 7f7 ,fund+ ,! ,secret>y ( ,vet]ans ,affairs %all transf] #bj1jjj1jjj = fiscal ye> #bjad1 & su* sums z may be necess>y = ea* fiscal ye> !reaft]1 f acc\nts ( ! ,vet]ans ,heal? ,adm9i/ration to ! ,secret>y ( ,heal? & ,human ,s]vices to aw>d s*ol>%ips & loan repaym5t contracts1 z describ$ 9 subsection 7a74 ,all funds s transf]r$ %all be us$ exclusively = ! purposes describ$ 9 su* subsection4 #bjf4 ,au?orization ( em]g5cy appropriations ,!re is au?oriz$ to be appropriat$ = ! ,dep>tm5t ( ,vet]ans ,affairs su* sums z may be necess>y to c>ry out ?is title4 ,,iii ,improvem5t ( ,access to ,c>e f ,non-,dep>tm5t ( ,vet]ans ,affairs ,provid]s #cja4 ,improvem5t ( access by vet]ans to heal? c>e f non-,dep>tm5t ( ,vet]ans ,affairs provid]s 7a7 ,improvem5t ( access 7#a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all ensure timely access ( all vet]ans to ! hospital c>e1 m$ical s]vices1 & o!r heal? c>e = :i* su* vet]ans are eligible "u ! laws adm9i/]$ by ! ,secret>y ?r\gh ! enhanc$ use ( au?orities specifi$ 9 p>agraph 7#b7 on ! provision ( su* c>e & s]vices ?r\gh non-,dep>tm5t ( ,vet]ans ,affairs provid]s 7commonly ref]r$ to z non-,dep>tm5t ( ,vet]ans ,affairs m$ical c>e74 7#b7 ,au?orities on provision ( c>e ?r\gh non-,dep>tm5t provid]s ,! au?orities specifi$ 9 ?is p>agraph are ! foll[+3 7,a7 ,section #agjc ( title #ch1 ,unit$ ,/ates ,code1 relat+ to contracts = ! provision ( hospital c>e & m$ical s]vices ?r\gh non-,dep>tm5t facilities4 7,b7 ,section #agbe ( su* title1 relat+ to reimbursem5t ( c]ta9 vet]ans = ! reasonable value ( em]g5cy treatm5t at non-,dep>tm5t facilities4 7,c7 ,section #agbh ( su* title1 relat+ to reimbursem5t ( c]ta9 vet]ans = cu/om>y & usual *>ges ( em]g5cy treatm5t f s\rces o!r ?an ! ,dep>tm5t4 7,d7 ,section #aghf ( su* title1 relat+ to heal? c>e s]vices furni%$ to newborn *ildr5 ( wom5 vet]ans :o are receiv+ mat]nity c>e furni%$ by ! ,dep>tm5t at a non-,dep>tm5t facility4 7,e7 ,any o!r au?ority "u ! laws adm9i/]$ by ! ,secret>y to provide hospital c>e1 m$ical s]vices1 or o!r heal? c>e f a non-,dep>tm5t provid]1 includ+ ! foll[+3 7i7 ,a ,f$]ally-qualifi$ heal? c5t] 7z def9$ 9 section #aije7l77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7774 7ii7 ,! ,dep>tm5t ( ,def5se4 7iii7 ,! ,indian ,heal? ,s]vice4 7#c7 ,requirem5ts ,9 ensur+ timely access ( all vet]ans to ! c>e & s]vices describ$ 9 p>agraph 7#a7 ?r\gh ! enhanc$ use ( au?orities specifi$ 9 p>agraph 7#b71 ! ,secret>y %all require ! foll[+3 7,a7 ,t ea* vet]an :o has n receiv$ hospital c>e1 m$ical s]vices1 or o!r heal? c>e f ! ,dep>tm5t & is seek+ an appo9tm5t = prim>y c>e "u ! laws adm9i/]$ by ! ,secret>y receive an appo9tm5t = prim>y c>e at a "t consi/5t ) timel9ess measures e/abli%$ by ! ,secret>y = purposes ( provid+ prim>y c>e to all vet]ans4 7,b7 ,t ! det]m9ation :e!r to ref] a vet]an = specialty c>e ?r\gh a non-,dep>tm5t provid] %all take into acc\nt ! urg5cy & acuity ( su* vet]an's ne$ = su* c>e1 includ+-- 7i7 ! sev]ity ( ! condition ( su* vet]an requir+ specialty c>e2 & 7ii7 ! wait-"t = an appo9tm5t ) a speciali/ ) respect to su* condition at ! ne>e/ m$ical facility ( ! ,dep>tm5t ) ! capacity to provide su* c>e4 7,c7 ,t ! det]m9ation :e!r a vet]an %all receive hospital c>e1 m$ical s]vices1 or o!r heal? c>e f ! ,dep>tm5t ?r\gh facilities ( ! ,dep>tm5t or ?r\gh non-,dep>tm5t provid]s pursuant to ! au?orities specifi$ 9 p>agraph 7#b7 %all take into acc\nt1 9 ! mann] specifi$ by ! ,secret>y1 ! foll[+3 7i7 ,! di/ance ! vet]an w\ld be requir$ to travel to receive c>e or s]vices ?r\gh a non-,dep>tm5t provid] comp>$ to ! di/ance ! vet]an w\ld be requir$ to travel to receive c>e or s]vices f a m$ical facility ( ! ,dep>tm5t4 7ii7 ,any factors t might limit ! ability ( ! vet]an to travel1 includ+ age1 access to transportation1 & infirmity4 7iii7 ,! wait-"t = ! provision ( c>e or s]vices ?r\gh a non-,dep>tm5t provid] comp>$ to ! wait-"t = ! provision ( c>e or s]vices f a m$ical facility ( ! ,dep>tm5t4 7iv7 ,:]e ! vet]an w\ld pref] to receive ! c>e & s]vices describ$ 9 p>agraph 7#a71 unless ! pref]5ce ( ! vet]an conflicts ) any ( ! o!r requirem5ts ( ?is p>agraph4 7,d7 ,t ! ,dep>tm5t maximize ! use ( hospital c>e1 m$ical s]vices1 & o!r heal? c>e available to ! ,dep>tm5t ?r\gh non-,dep>tm5t provid]s1 includ+ provid]s available to provide su* c>e & s]vices z foll[s3 7i7 ,pursuant to contracts "u ! ,pati5t-,c5t]$ ,community ,c>e ,program ( ! ,dep>tm5t4 7ii7 ,pursuant to contracts betwe5 a facility or facilities ( ! ,dep>tm5t & a local facility or provid]4 7iii7 ,pursuant to contracts ) ,f$]ally-qualifi$ heal? c5t]s 7z def9$ 9 section #aije7l77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7771 ! ,dep>tm5t ( ,def5se1 or ! ,indian ,heal? ,s]vice4 7iv7 ,on a fee-=-s]vice basis4 7b7 ,m$ical records ,9 provid+ hospital c>e1 m$ical s]vices1 & o!r heal? c>e to vet]ans ?r\gh non-,dep>tm5t provid]s pursuant to ! au?orities specifi$ 9 p>agraph 7#b71 ! ,secret>y %all ensure t any su* provid] submits to ! ,dep>tm5t any m$ical record relat$ to ! c>e & s]vices provid$ to a vet]an by t provid] = inclusion 9 ! electronic m$ical record ( su* vet]an ma9ta9$ by ! ,dep>tm5t ^u ! completion ( ! provision ( su* c>e & s]vices to su* vet]an4 7c7 ,reports 7#a7 ,initial report ,n lat] ?an #de days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report on ! implem5tation ( ! requirem5ts "u subsection 7a7 & 7b71 includ+ a plan to en=ce ! prop] implem5tation ( su* requirem5ts sy/ematically ?r\gh\t ! ,dep>tm5t4 7#b7 ,p]iodic reports ,n lat] ?an #ij days aft] ! submittal ( ! report requir$ by p>agraph 7#a71 & e #ij days !reaft] = "o ye>1 ! ,secret>y %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report t includes ! foll[+3 7,a7 ,! progress ( ! ,secret>y 9 c>ry+ out ! plan "u p>agraph 7#a7 to en=ce ! prop] implem5tation ( ! requirem5ts "u subsection 7a7 & 7b7 sy/ematically ?r\gh\t ! ,dep>tm5t4 7,b7 ,! impact ( ! implem5tation ( su* requirem5ts on wait-times = vet]ans to receive hospital c>e1 m$ical s]vices1 & o!r heal? c>e1 disaggregat$ by-- 7i7 new pati5ts2 7ii7 exi/+ pati5ts2 7iii7 prim>y c>e2 & 7iv7 specialty c>e4 7,c7 ,any recomm5dations = *anges or improvem5ts to su* requirem5ts4 7,d7 ,any reque/s = additional fund+ necess>y to c>ry out su* requirem5ts4 #cjb4 ,ext5sion ( & report on jo9t inc5tives program ( ,dep>tm5t ( ,vet]ans ,affairs & ,dep>tm5t ( ,def5se 7a7 ,ext5sion ,section #haaa7;d77#c7 ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by /rik+ ,septemb] #cj1 #bjae & ins]t+ ,septemb] #cj1 #bjbj4 7b7 ,reports 7#a7 ,report on implem5tation ( recomm5dations ,n lat] ?an #fj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs & ! ,secret>y ( ,def5se %all jo9tly submit to ,congress a report on ! implem5tation by ! ,dep>tm5t ( ,vet]ans ,affairs & ! ,dep>tm5t ( ,def5se ( ! f9d+s & recomm5dations ( ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates 9 ! ,septemb] #bjab report entitl$ ,,va & ,do,d ,heal? ,c>e3 ,dep>tm5t-,level ,actions ,ne$$ to ,assess ,collaboration ,p]=mance1 ,address ,b>ri]s1 & ,id5tify ,opportunities 7,,gao-#ab-iib74 7#b7 ,comptroll] ,g5]al report 7,a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ,congress a report assess+ & provid+ recomm5dations = improvem5t to ! program to id5tify1 provide inc5tives to1 implem5t1 fund1 & evaluate creative coord9ation & %>+ initiatives betwe5 ! ,dep>tm5t ( ,vet]ans ,affairs & ! ,dep>tm5t ( ,def5se requir$ "u section #haaa7;d7 ( su* title4 7,b7 ,elem5ts ,! report requir$ by subp>agraph 7,a7 %all include ! foll[+3 7i7 ,an assessm5t ( ! ext5t to :i* ! program describ$ 9 subp>agraph 7,a7 has accompli%$ ! goal ( su* program to improve ! access to1 & quality & co/ effectiv5ess (1 ! heal? c>e provid$ by ! ,vet]ans ,heal? ,adm9i/ration & ! ,milit>y ,heal? ,sy/em to ! b5efici>ies ( bo? ! ,dep>tm5t ( ,vet]ans ,affairs & ! ,dep>tm5t ( ,def5se4 7ii7 ,an assessm5t ( :e!r adm9i/ration ( su* program ?r\gh ! ,heal? ,executive ,committee ( ! ,dep>tm5t ( ,vet]ans ,affairs-,dep>tm5t ( ,def5se ,jo9t ,executive ,committee e/abli%$ "u section #cbj ( su* title provides suffici5t lead]%ip att5tion & ov]sight to ensure maximum b5efits to ! ,dep>tm5t ( ,vet]ans ,affairs & ! ,dep>tm5t ( ,def5se ?r\gh collaborative ef=ts4 7iii7 ,an assessm5t ( :e!r additional au?orities to jo9tly con/ruct1 lease1 or acquire facilities w\ld facilitate additional collaborative ef=ts "u su* program4 7iv7 ,an assessm5t ( :e!r ! fund+ = su* program is suffici5t to ensure consi/5t id5tification ( pot5tial opportunities = collaboration & ov]sight ( exi/+ collaborations to ensure a mean+ful p>tn]%ip betwe5 ! ,dep>tm5t ( ,vet]ans ,affairs & ! ,dep>tm5t ( ,def5se & remove any b>ri]s to integration or collaboration4 7v7 ,an assessm5t ( :e!r exi/+ processes = id5tify+ opportunities = collaboration are suffici5t to ensure maximum collaboration betwe5 ! ,vet]ans ,heal? ,adm9i/ration & ! ,milit>y ,heal? ,sy/em4 7vi7 ,su* legislative or adm9i/rative recomm5dations = improvem5t to su* program z ! ,comptroll] ,g5]al consid]s appropriate to enhance ! use ( su* program to increase access to heal? c>e4 #cjc4 ,transf] ( au?ority = paym5ts = hospital c>e1 m$ical s]vices1 & o!r heal? c>e f non-,dep>tm5t provid]s to ! ,*ief ,bus9ess ,(fice ( ! ,vet]ans ,heal? ,adm9i/ration ( ! ,dep>tm5t 7a7 ,transf] ( au?ority 7#a7 ,9 g5]al ,effective on ,octob] #a1 #bjad1 ! ,secret>y ( ,vet]ans ,affairs %all transf] ! au?ority to pay = hospital c>e1 m$ical s]vices1 & o!r heal? c>e ?r\gh non-,dep>tm5t provid]s to ! ,*ief ,bus9ess ,(fice ( ! ,vet]ans ,heal? ,adm9i/ration ( ! ,dep>tm5t ( ,vet]ans ,affairs f ! ,vet]ans ,integrat$ ,s]vice ,networks & m$ical c5t]s ( ! ,dep>tm5t ( ,vet]ans ,affairs4 7#b7 ,mann] ( c>e ,! ,*ief ,bus9ess ,(fice %all "w 9 consultation ) ! ,(fice ( ,cl9ical ,op]ations & ,managem5t ( ! ,dep>tm5t ( ,vet]ans ,affairs to ensure t c>e & s]vices describ$ 9 p>agraph 7#a7 is provid$ 9 a mann] t is cl9ically appropriate & effective4 7#c7 ,no delay 9 paym5t ,! transf] ( au?ority "u p>agraph 7#a7 %all be c>ri$ out 9 a mann] t does n delay or imp$e any paym5t by ! ,dep>tm5t = hospital c>e1 m$ical s]vices1 or o!r heal? c>e provid$ ?r\gh a non-,dep>tm5t provid] "u ! laws adm9i/]$ by ! ,secret>y4 7b7 ,budget>y effect ,! ,secret>y %all1 = ea* fiscal ye> t beg9s aft] ! date ( ! enactm5t ( ?is ,act-- 7#a7 include 9 ! budget = ! ,*ief ,bus9ess ,(fice ( ! ,vet]ans ,heal? ,adm9i/ration am\nts to pay = hospital c>e1 m$ical s]vices1 & o!r heal? c>e provid$ ?r\gh non-,dep>tm5t provid]s1 includ+ any am\nts necess>y to c>ry out ! transf] ( au?ority to pay = su* c>e & s]vices "u subsection 7a71 includ+ any increase 9 /aff2 & 7#b7 n include 9 ! budget ( ea* ,vet]ans ,integrat$ ,s]vice ,network & m$ical c5t] ( ! ,dep>tm5t am\nts to pay = su* c>e & s]vices4 7c7 ,removal f p]=mance goals ,= ea* fiscal ye> t beg9s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all n include 9 ! p]=mance goals ( any employee ( a ,vet]ans ,integrat$ ,s]vice ,network or m$ical c5t] ( ! ,dep>tm5t any p]=mance goal t might dis9c5tivize ! paym5t ( ,dep>tm5t am\nts to provide hospital c>e1 m$ical s]vices1 or o!r heal? c>e ?r\gh a non-,dep>tm5t provid]4 #cjd4 ,enhancem5t ( collaboration betwe5 ,dep>tm5t ( ,vet]ans ,affairs & ,indian ,heal? ,s]vice 7a7 ,outrea* to tribal-run m$ical facilities ,! ,secret>y ( ,vet]ans ,affairs %all1 9 consultation ) ! ,director ( ! ,indian ,heal? ,s]vice1 conduct outrea* to ea* m$ical facility op]at$ by an ,indian tribe or tribal organization ?r\gh a contract or compact ) ! ,indian ,heal? ,s]vice "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq47 to raise aw>5ess ( ! ability ( su* facilities1 ,indian tribes1 & tribal organizations to ent] into agreem5ts ) ! ,dep>tm5t ( ,vet]ans ,affairs "u :i* ! ,secret>y reimburses su* facilities1 ,indian tribes1 or tribal organizations1 z ! case may be1 = heal? c>e provid$ to vet]ans eligible = heal? c>e at su* facilities4 7b7 ,metrics = memor&um ( und]/&+ p]=mance ,! ,secret>y ( ,vet]ans ,affairs %all implem5t p]=mance metrics = assess+ ! p]=mance by ! ,dep>tm5t ( ,vet]ans ,affairs & ! ,indian ,heal? ,s]vice "u ! memor&um ( und]/&+ entitl$ ,memor&um ( ,und]/&+ betwe5 ! ,dep>tm5t ( ,vet]ans ,affairs 7,,va7 & ! ,indian ,heal? ,s]vice 7,,ihs7 9 increas+ access to heal? c>e1 improv+ quality & coord9ation ( heal? c>e1 promot+ effective pati5t-c5t]$ collaboration & p>tn]%ips betwe5 ! ,dep>tm5t & ! ,s]vice1 & ensur+ heal?-promotion & disease-prev5tion s]vices are appropriately fund$ & available = b5efici>ies "u bo? heal? c>e sy/ems4 7c7 ,report ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs & ! ,director ( ! ,indian ,heal? ,s]vice %all jo9tly submit to ,congress a report on ! feasibility & advisability ( ! foll[+3 7#a7 ,ent]+ into agreem5ts = ! reimbursem5t by ! ,secret>y ( ! co/s ( direct c>e s]vices provid$ ?r\gh organizations receiv+ am\nts pursuant to grants made or contracts ent]$ into "u section #ejc ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afec7 to vet]ans :o are o!rwise eligible to receive heal? c>e f su* organizations4 7#b7 ,includ+ ! reimbursem5t ( ! co/s ( direct c>e s]vices provid$ to vet]ans :o are n ,indians 9 agreem5ts betwe5 ! ,dep>tm5t & ! foll[+3 7,a7 ,! ,indian ,heal? ,s]vice4 7,b7 ,an ,indian tribe or tribal organization op]at+ a m$ical facility ?r\gh a contract or compact ) ! ,indian ,heal? ,s]vice "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq474 7,c7 ,a m$ical facility ( ! ,indian ,heal? ,s]vice4 7d7 ,def9itions ,9 ?is section3 7#a7 ,indian ,! t]ms ,indian & ,indian tribe h ! mean+s giv5 ^? t]ms 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc74 7#b7 ,m$ical facility ( ! ,indian ,heal? ,s]vice ,! t]m m$ical facility ( ! ,indian ,heal? ,s]vice includes a facility op]at$ by an ,indian tribe or tribal organization ?r\gh a contract or compact ) ! ,indian ,heal? ,s]vice "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq474 7#c7 ,tribal organization ,! t]m tribal organization has ! mean+ giv5 ! t]m 9 section #d ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej;b74 #cje4 ,enhancem5t ( collaboration betwe5 ,dep>tm5t ( ,vet]ans ,affairs & ,native ,hawaiian heal? c>e sy/ems 7a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all1 9 consultation ) ,papa ,ola ,lokahi & su* o!r organizations involv$ 9 ! deliv]y ( heal? c>e to ,native ,hawaiians z ! ,secret>y consid]s appropriate1 ent] into contracts or agreem5ts ) ,native ,hawaiian heal? c>e sy/ems t are 9 receipt ( funds f ! ,secret>y ( ,heal? & ,human ,s]vices pursuant to grants aw>d$ or contracts ent]$ into "u section #f7;a7 ( ! ,native ,hawaiian ,heal? ,c>e ,improvem5t ,act 7#db ,u4,s4,c4 #aagje7;a77 = ! reimbursem5t ( direct c>e s]vices provid$ to eligible vet]ans z specifi$ 9 su* contracts or agreem5ts4 7b7 ,def9itions ,9 ?is section1 ! t]ms ,native ,hawaiian1 ,native ,hawaiian heal? c>e sy/em1 & ,papa ,ola ,lokahi h ! mean+s giv5 ^? t]ms 9 section #ab ( ! ,native ,hawaiian ,heal? ,c>e ,improvem5t ,act 7#db ,u4,s4,c4 #aagaa74 #cjf4 ,au?orization ( em]g5cy appropriations ,!re is au?oriz$ to be appropriat$ = ! ,dep>tm5t ( ,vet]ans ,affairs su* sums z may be necess>y to c>ry out ?is title4 ,,iv ,heal? ,c>e ,adm9i/rative ,matt]s #dja4 ,improvem5t ( access ( vet]ans to mobile vet c5t]s ( ! ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,improvem5t ( access 7#a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all improve ! access ( vet]ans to telem$ic9e & o!r heal? c>e ?r\gh ! use ( mobile vet c5t]s ( ! ,dep>tm5t ( ,vet]ans ,affairs by provid+ /&>diz$ requirem5ts = ! op]ation ( su* c5t]s4 7#b7 ,requirem5ts ,! /&>diz$ requirem5ts requir$ by p>agraph 7#a7 %all include ! foll[+3 7,a7 ,! numb] ( days ea* mobile vet c5t] ( ! ,dep>tm5t is expect$ to travel p] ye>4 7,b7 ,! numb] ( locations ea* c5t] is expect$ to visit p] ye>4 7,c7 ,! numb] ( appo9tm5ts ea* c5t] is expect$ to conduct p] ye>4 7,d7 ,! me?od & tim+ ( notifications giv5 by ea* c5t] to individuals 9 ! area to :i* su* c5t] is travel+1 includ+ notifications in=m+ vet]ans ( ! availability to s*$ule appo9tm5ts at ! c5t]4 7#c7 ,use ( telem$ic9e ,! ,secret>y %all ensure t ea* mobile vet c5t] ( ! ,dep>tm5t has ! capability to provide telem$ic9e s]vices4 7b7 ,reports ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 & n lat] ?an ,septemb] #cj ea* ye> !reaft]1 ! ,secret>y ( ,vet]ans ,affairs %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report on ! foll[+3 7#a7 ,! use ( mobile vet c5t]s to provide telem$ic9e s]vices to vet]ans dur+ ! ye> prec$+ ! submittal ( ! report1 includ+ ! foll[+3 7,a7 ,! numb] ( days ea* mobile vet c5t] 0 op5 to provide su* s]vices4 7,b7 ,! numb] ( days ea* mobile vet c5t] travel$ to a location o!r ?an ! headqu>t]s ( ! mobile vet c5t] to provide su* s]vices4 7,c7 ,! numb] ( appo9tm5ts ea* c5t] conduct$ to provide su* s]vices on av]age p] mon? & 9 total dur+ su* ye>4 7#b7 ,an analysis ( ! effectiv5ess ( us+ mobile vet c5t]s to provide heal? c>e s]vices to vet]ans ?r\gh ! use ( telem$ic9e4 7#c7 ,any recomm5dations = an increase 9 ! numb] ( mobile vet c5t]s ( ! ,dep>tm5t4 7#d7 ,any recomm5dations = an increase 9 ! telem$ic9e capabilities ( ea* mobile vet c5t]4 7#e7 ,! feasibility & advisability ( us+ tempor>y heal? c>e provid]s1 includ+ locum t55s1 to provide direct heal? c>e s]vices to vet]ans at mobile vet c5t]s4 7#f7 ,su* o!r recomm5dations on improvem5t ( ! use ( mobile vet c5t]s by ! ,dep>tm5t z ! ,secret>y consid]s appropriate4 #djb4 ,commission on ,access to ,c>e 7a7 ,e/abli%m5t ( commission 7#a7 ,9 g5]al ,!re is e/abli%$ ! ,commission on ,access to ,c>e 79 ?is section ref]r$ to z ! ,commission7 to exam9e ! access ( vet]ans to heal? c>e f ! ,dep>tm5t ( ,vet]ans ,affairs & /rategically exam9e h[ be/ to organize ! ,vet]ans ,heal? ,adm9i/ration1 locate heal? c>e res\rces1 & deliv] heal? c>e to vet]ans dur+ ! next #aj to #bj ye>s4 7#b7 ,memb]%ip 7,a7 ,vot+ memb]s ,! ,commission %all be compos$ ( #aj vot+ memb]s :o are appo9t$ by ! ,presid5t z foll[s3 7i7 ,at lea/ two memb]s :o repres5t an organization recogniz$ by ! ,secret>y ( ,vet]ans ,affairs = ! repres5tation ( vet]ans "u section #eijb ( title #ch1 ,unit$ ,/ates ,code4 7ii7 ,at lea/ "o memb] f among p]sons :o are exp]ts conc]n+ a public or private hospital sy/em4 7iii7 ,at lea/ "o memb] f among p]sons :o are famili> ) gov]nm5t heal? c>e sy/ems1 includ+ ^? sy/ems ( ! ,dep>tm5t ( ,def5se1 ! ,indian ,heal? ,s]vice1 & ,f$]ally-qualifi$ heal? c5t]s 7z def9$ 9 section #aije7l77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7774 7iv7 ,at lea/ two memb]s f among p]sons :o are famili> ) ! ,vet]ans ,heal? ,adm9i/ration4 7,b7 ,nonvot+ memb]s ,9 addition to memb]s appo9t$ "u subp>agraph 7,a71 ! ,commission %all be compos$ ( #aj nonvot+ memb]s :o are appo9t$ by ! ,presid5t z foll[s3 7i7 ,at lea/ two memb]s :o repres5t an organization recogniz$ by ! ,secret>y ( ,vet]ans ,affairs = ! repres5tation ( vet]ans "u section #eijb ( title #ch1 ,unit$ ,/ates ,code4 7ii7 ,at lea/ "o memb] f among p]sons :o are exp]ts 9 a public or private hospital sy/em4 7iii7 ,at lea/ "o memb] f among p]sons :o are famili> ) gov]nm5t heal? c>e sy/ems1 includ+ ^? sy/ems ( ! ,dep>tm5t ( ,def5se1 ! ,indian ,heal? ,s]vice1 & ,f$]ally-qualifi$ heal? c5t]s 7z def9$ 9 section #aije7l77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7774 7iv7 ,at lea/ two memb]s f among p]sons :o are famili> ) ! ,vet]ans ,heal? ,adm9i/ration4 7,c7 ,date ,! appo9tm5ts ( memb]s ( ! ,commission %all be made n lat] ?an #fj days aft] ! date ( ! enactm5t ( ?is ,act4 7#c7 ,p]iod ( appo9tm5t2 vacancies ,memb]s %all be appo9t$ = ! life ( ! ,commission4 ,any vacancy 9 ! ,commission %all n affect its p[]s1 b %all be fill$ 9 ! same mann] z ! orig9al appo9tm5t4 7#d7 ,initial meet+ ,n lat] ?an #ae days aft] ! date on :i* sev5 vot+ memb]s ( ! ,commission h be5 appo9t$1 ! ,commission %all hold its fir/ meet+4 7#e7 ,meet+s ,! ,commission %all meet at ! call ( ! ,*airp]son4 7#f7 ,quorum ,a majority ( ! memb]s ( ! ,commission %all con/itute a quorum1 b a less] numb] ( memb]s may hold he>+s4 7#g7 ,*airp]son & ,vice ,*airp]son ,! ,commission %all select a ,*airp]son & ,vice ,*airp]son f among its memb]s4 7b7 ,duties ( commission 7#a7 ,evaluation & assessm5t ,! ,commission %all und]take a compreh5sive evaluation & assessm5t ( access to heal? c>e at ! ,dep>tm5t ( ,vet]ans ,affairs4 7#b7 ,matt]s evaluat$ & assess$ ,! matt]s evaluat$ & assess$ by ! ,commission %all include ! foll[+3 7,a7 ,! appropriat5ess ( curr5t /&>ds ( ! ,dep>tm5t ( ,vet]ans ,affairs conc]n+ access to heal? c>e4 7,b7 ,! measurem5t ( su* /&>ds4 7,c7 ,! appropriat5ess ( p]=mance /&>ds & inc5tives 9 relation to /&>ds describ$ 9 subp>agraph 7,a74 7,d7 ,/aff+ levels ?r\gh\t ! ,vet]ans ,heal? ,adm9i/ration & :e!r !y are suffici5t to meet curr5t dem& = heal? c>e f ! ,adm9i/ration4 7#c7 ,reports ,! ,commission %all submit to ! ,presid5t1 ?r\gh ! ,secret>y ( ,vet]ans ,affairs1 reports z foll[s3 7,a7 ,n lat] ?an #ij days aft] ! date ( ! initial meet+ ( ! ,commission1 an int]im report on-- 7i7 ! f9d+s ( ! ,commission ) respect to ! evaluation & assessm5t requir$ by ?is subsection2 & 7ii7 su* recomm5dations z ! ,commission may h = legislative or adm9i/rative action to improve access to heal? c>e ?r\gh ! ,vet]ans ,heal? ,adm9i/ration4 7,b7 ,n lat] ?an #ahj days aft] ! date ( ! initial meet+ ( ! ,commission1 a f9al report on-- 7i7 ! f9d+s ( ! ,commission ) respect to ! evaluation & assessm5t requir$ by ?is subsection2 & 7ii7 su* recomm5dations z ! ,commission may h = legislative or adm9i/rative action to improve access to heal? c>e ?r\gh ! ,vet]ans ,heal? ,adm9i/ration4 7c7 ,p[]s ( ! commission 7#a7 ,he>+s ,! ,commission may hold su* he>+s1 sit & act at su* times & places1 take su* te/imony1 & receive su* evid5ce z ! ,commission consid]s advisable to c>ry out ?is section4 7#b7 ,in=mation f ,f$]al ag5cies ,! ,commission may secure directly f any ,f$]al dep>tm5t or ag5cy su* in=mation z ! ,commission consid]s necess>y to c>ry out ?is section4 ,^u reque/ ( ! ,*airp]son ( ! ,commission1 ! head ( su* dep>tm5t or ag5cy %all furni% su* in=mation to ! ,commission4 7d7 ,commission p]sonnel matt]s 7#a7 ,comp5sation ( memb]s ,ea* memb] ( ! ,commission :o is n an (fic] or employee ( ! ,f$]al ,gov]nm5t %all be comp5sat$ at a rate equal to ! daily equival5t ( ! annual rate ( basic pay prescrib$ = level ,,iv ( ! ,executive ,s*$ule "u section #ecae ( title #e1 ,unit$ ,/ates ,code1 = ea* day 7includ+ travel "t7 dur+ :i* su* memb] is engag$ 9 ! p]=mance ( ! duties ( ! ,commission4 ,all memb]s ( ! ,commission :o are (fic]s or employees ( ! ,unit$ ,/ates %all s]ve )\t comp5sation 9 addition to t receiv$ = _! s]vices z (fic]s or employees ( ! ,unit$ ,/ates4 7#b7 ,travel exp5ses ,! memb]s ( ! ,commission %all be all[$ travel exp5ses1 includ+ p] diem 9 lieu ( subsi/5ce1 at rates au?oriz$ = employees ( ag5cies "u sub*apt] ,i ( *apt] #eg ( title #e1 ,unit$ ,/ates ,code1 :ile away f _! homes or regul> places ( bus9ess 9 ! p]=mance ( s]vices = ! ,commission4 7#c7 ,/aff 7,a7 ,9 g5]al ,! ,*airp]son ( ! ,commission may1 )\t reg>d to ! civil s]vice laws & regulations1 appo9t & t]m9ate an executive director & su* o!r additional p]sonnel z may be necess>y to enable ! ,commission to p]=m its duties4 ,! employm5t ( an executive director %all be subject to confirmation by ! ,commission4 7,b7 ,comp5sation ,! ,*airp]son ( ! ,commission may fix ! comp5sation ( ! executive director & o!r p]sonnel )\t reg>d to *apt] #ea & sub*apt] ,,iii ( *apt] #ec ( title #e1 ,unit$ ,/ates ,code1 relat+ to classification ( positions & ,g5]al ,s*$ule pay rates1 except t ! rate ( pay = ! executive director & o!r p]sonnel may n exce$ ! rate payable = level ,v ( ! ,executive ,s*$ule "u section #ecaf ( su* title4 7#d7 ,detail ( gov]nm5t employees ,any ,f$]al ,gov]nm5t employee may be detail$ to ! ,commission )\t reimbursem5t1 & su* detail %all be )\t int]ruption or loss ( civil s]vice /atus or privilege4 7#e7 ,procurem5t ( tempor>y & int]mitt5t s]vices ,! ,*airp]son ( ! ,commission may procure tempor>y & int]mitt5t s]vices "u section #caji7;b7 ( title #e1 ,unit$ ,/ates ,code1 at rates = individuals :i* d n exce$ ! daily equival5t ( ! annual rate ( basic pay prescrib$ = level ,v ( ! ,executive ,s*$ule "u section #ecaf ( su* title4 7e7 ,t]m9ation ( ! commission ,! ,commission %all t]m9ate #cj days aft] ! date on :i* ! ,commission submits its report "u subsection 7b77#c77;,b74 7f7 ,fund+ ,! ,secret>y ( ,vet]ans ,affairs %all make available to ! ,commission f am\nts appropriat$ or o!rwise made available to ! ,secret>y su* am\nts z ! ,secret>y & ! ,*airp]son ( ! ,commission jo9tly consid] appropriate = ! ,commission to p]=m its duties "u ?is section4 7g7 ,executive action 7#a7 ,action on recomm5dations ,! ,presid5t %all require ! ,secret>y ( ,vet]ans ,affairs & su* o!r heads ( relevant ,f$]al dep>tm5ts & ag5cies to implem5t ea* recomm5dation set =? 9 a report submitt$ "u subsection 7b77#c7 t ! ,presid5t-- 7,a7 consid]s feasible & advisable2 & 7,b7 det]m9es c be implem5t$ )\t fur!r legislative action4 7#b7 ,reports ,n lat] ?an #fj days aft] ! date on :i* ! ,presid5t receives a report "u subsection 7b77#c71 ! ,presid5t %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives & su* o!r committees ( ,congress z ! ,presid5t consid]s appropriate a report sett+ =? ! foll[+3 7,a7 ,an assessm5t ( ! feasibility & advisability ( ea* recomm5dation conta9$ 9 ! report receiv$ by ! ,presid5t4 7,b7 ,= ea* recomm5dation assess$ z feasible & advisable "u subp>agraph 7,a7 ! foll[+3 7i7 ,:e!r su* recomm5dation requires legislative action4 7ii7 ,if su* recomm5dation requires legislative action1 a recomm5dation conc]n+ su* legislative action4 7iii7 ,a description ( any adm9i/rative action already tak5 to c>ry out su* recomm5dation4 7iv7 ,a description ( any adm9i/rative action ! ,presid5t int5ds to be tak5 to c>ry out su* recomm5dation & by :om4 #djc4 ,commission on ,capital ,plann+ = ,dep>tm5t ( ,vet]ans ,affairs ,m$ical ,facilities 7a7 ,e/abli%m5t ( commission 7#a7 ,e/abli%m5t ,!re is e/abli%$ ! ,commission on ,capital ,plann+ = ,dep>tm5t ( ,vet]ans ,affairs ,m$ical ,facilities 79 ?is section ref]r$ to z ! ,commission74 7#b7 ,memb]%ip 7,a7 ,vot+ memb]s ,! ,commission %all1 subject to subp>agraph 7,b71 be compos$ ( #aj vot+ memb]s z foll[s3 7i7 #a %all be appo9t$ by ! ,presid5t4 7ii7 #a %all be appo9t$ by ! ,adm9i/rator ( ,g5]al ,s]vices4 7iii7 #c %all be appo9t$ by ! ,secret>y ( ,vet]ans ,affairs1 ( :om-- 7,i7 #a %all be an employee ( ! ,vet]ans ,heal? ,adm9i/ration2 7,,ii7 #a %all be an employee ( ! ,(fice ( ,asset ,ent]prise ,managem5t ( ! ,dep>tm5t ( ,vet]ans ,affairs2 & 7,,iii7 #a %all be an employee ( ! ,(fice ( ,con/ruction & ,facilities ,managem5t ( ! ,dep>tm5t ( ,vet]ans ,affairs4 7iv7 #a %all be appo9t$ by ! ,secret>y ( ,def5se f among employees ( ! ,army ,corps ( ,eng9e]s4 7v7 #a %all be appo9t$ by ! majority lead] ( ! ,s5ate4 7vi7 #a %all be appo9t$ by ! m9ority lead] ( ! ,s5ate4 7vii7 #a %all be appo9t$ by ! ,speak] ( ! ,h\se ( ,repres5tatives4 7viii7 #a %all be appo9t$ by ! m9ority lead] ( ! ,h\se ( ,repres5tatives4 7,b7 ,requirem5t relat+ to c]ta9 appo9tm5ts ( vot+ memb]s ,( ! memb]s appo9t$ pursuant to clause 7i71 7ii71 & 7iv7 ?r\gh 7viii7 ( subp>agraph 7,a71 all %all h exp]tise 9 capital leas+1 con/ruction1 or heal? facility managem5t plann+4 7,c7 ,non-vot+ memb]s ,! ,commission %all be assi/$ by #aj non-vot+ memb]s1 appo9t$ by ! vote ( a majority ( memb]s ( ! ,commission "u subp>agraph 7,a71 ( :om-- 7i7 #f %all be repres5tatives ( vet]ans s]vice organizations recogniz$ by ! ,secret>y ( ,vet]ans ,affairs2 & 7ii7 #d %all be individuals f outside ! ,dep>tm5t ( ,vet]ans ,affairs ) exp]i5ce & exp]tise 9 matt]s relat+ to managem5t1 con/ruction1 & leas+ ( capital assets4 7,d7 ,date ( appo9tm5t ( vot+ memb]s ,! appo9tm5ts ( ! memb]s ( ! ,commission "u subp>agraph 7,a7 %all be made n lat] ?an #fj days aft] ! date ( ! enactm5t ( ?is ,act4 7#c7 ,p]iod ( appo9tm5t2 vacancies ,memb]s %all be appo9t$ = ! life ( ! ,commission4 ,any vacancy 9 ! ,commission %all n affect its p[]s1 b %all be fill$ 9 ! same mann] z ! orig9al appo9tm5t4 7#d7 ,initial meet+ ,n lat] ?an #ae days aft] ! date on :i* #g memb]s ( ! ,commission h be5 appo9t$1 ! ,commission %all hold its fir/ meet+4 7#e7 ,meet+s ,! ,commission %all meet at ! call ( ! ,*air4 7#f7 ,quorum ,a majority ( ! memb]s ( ! ,commission %all con/itute a quorum1 b a less] numb] ( memb]s may hold he>+s4 7#g7 ,*air & vice *air ,! ,commission %all select a ,*air & ,vice ,*air f among its memb]s4 7b7 ,duties ( commission 7#a7 ,9 g5]al ,! ,commission %all und]take a compreh5sive evaluation & assessm5t ( v>i\s options = capital plann+ = ,dep>tm5t ( ,vet]ans ,affairs m$ical facilities1 includ+ an evaluation & assessm5t ( ! me*anisms by :i* ! ,dep>tm5t curr5tly selects means = ! deliv]y ( heal? c>e1 :e!r by major con/ruction1 major m$ical facility leases1 %>+ agreem5ts ) ! ,dep>tm5t ( ,def5se1 ! ,indian ,heal? ,s]vice1 & ,f$]ally ,qualifi$ ,heal? ,cl9ics "u section #ccj ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;b71 contract c>e1 multisite c>e1 telem$ic9e1 ext5d$ h\rs = c>e1 or o!r means4 7#b7 ,context ( evaluation & assessm5t ,9 und]tak+ ! evaluation & assessm5t1 ! ,commission %all consid]-- 7,a7 ! importance ( access to heal? c>e ?r\gh ! ,dep>tm5t1 includ+ associat$ guidel9es ( ! ,dep>tm5t on access to1 & drive "t =1 heal? c>e2 7,b7 limitations & requirem5ts applicable to ! con/ruction & leas+ ( m$ical facilities = ! ,dep>tm5t1 includ+ applicable laws1 regulations1 & co/s z det]m9$ by bo? ! ,congressional ,budget ,(fice & ! ,(fice ( ,managem5t & ,budget2 7,c7 ! nature ( capital plann+ = ,dep>tm5t m$ical facilities 9 an era ( fiscal unc]ta9ty2 7,d7 project$ future fluctuations 9 ! population ( vet]ans2 & 7,e7 ! ext5t to :i* ! ,dep>tm5t 0 able to meet ! m&ates ( ! ,capital ,asset ,realignm5t = ,enhanc$ ,s]vices ,commission4 7#c7 ,p>ticul> consid]ations ,9 und]tak+ ! evaluation & assessm5t1 ! ,commission %all address1 9 p>ticul>1 ! foll[+3 7,a7 ,! ,major ,m$ical ,facility ,lease ,program ( ! ,dep>tm5t1 includ+ an id5tification ( pot5tial improvem5ts to ! lease au?orization processes "u t ,program4 7,b7 ,! managem5t processes ( ! ,dep>tm5t = its ,major ,m$ical ,facility ,con/ruction ,program1 includ+ processes relat+ to contract aw>d & managem5t1 project managem5t1 & process+ ( *ange ord]s4 7,c7 ,! ov]all capital plann+ program ( ! ,dep>tm5t = m$ical facilities1 includ+ an evaluation & assessm5t (-- 7i7 ! mann] 9 :i* ! ,dep>tm5t det]m9es :e!r to use capital or non-capital means to exp& access to heal? c>e2 7ii7 ! mann] 9 :i* ! ,dep>tm5t det]m9es ! disposition ( "u-utiliz$ & un-utiliz$ build+s on campuses ( ,dep>tm5t m$ical c5t]s1 & any b>ri]s to disposition2 7iii7 ! effectiv5ess ( ! facility ma/] plann+ initiative ( ! ,dep>tm5t2 & 7iv7 ! ext5t to :i* su/a9able attributes are plann$ = to decrease op]at+ co/s = ,dep>tm5t m$ical facilities4 7,d7 ,! curr5t backlog ( con/ruction projects = ,dep>tm5t m$ical facilities1 includ+ an id5tification ( ! mo/ effective means to quickly secure ! mo/ critical repairs requir$1 includ+ repairs relat+ to facility condition defici5cies1 /ructural safety1 & compliance ) ! ,am]icans ,) ,disabilities ,act ( #aiij4 7#d7 ,reports ,subject to p>agraph 7#e71 ! ,commission %all submit to ! ,secret>y ( ,vet]ans ,affairs1 & to ! ,committee ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives1 reports z foll[s3 7,a7 ,n lat] ?an six mon?s aft] its initial meet+ "u subsection 7a77#d71 a report on ! ,major ,m$ical ,facility ,lease ,program & ! ,congressional lease au?orization process4 7,b7 ,n lat] ?an "o ye> aft] its initial meet+1 a report-- 7i7 on ! managem5t processes ( ! ,dep>tm5t = ! con/ruction ( ,dep>tm5t m$ical facilities2 & 7ii7 sett+ =? an update ( any matt]s cov]$ 9 ! report "u subp>agraph 7,a74 7,c7 ,n lat] ?an #ah mon?s aft] its initial meet+1 a report-- 7i7 on ! ov]all capital plann+ program ( ! ,dep>tm5t = m$ical facilities2 & 7ii7 sett+ =? an update ( any matt]s cov]$ 9 e>li] reports "u ?is p>agraph4 7,d7 ,n lat] ?an two ye>s aft] its initial meet+1 a report-- 7i7 on ! curr5t backlog ( con/ruction projects = ,dep>tm5t m$ical facilities2 7ii7 sett+ =? an update ( any matt]s cov]$ 9 e>li] reports "u ?is p>agraph2 & 7iii7 includ+ su* o!r matt]s relat+ to ! duties ( ! ,commission t ! ,commission consid]s appropriate4 7,e7 ,n lat] ?an #bg mon?s aft] its initial meet+1 a report on ! implem5tation by ! ,secret>y ( ,vet]ans ,affairs pursuant to subsection 7g7 ( ! recomm5dations includ$ pursuant to p>agraph 7#e7 9 ! reports "u ?is p>agraph4 7#e7 ,recomm5dations ,ea* report "u p>agraph 7#d7 %all include1 = ! aspect ( ! capital asset plann+ process ( ! ,dep>tm5t cov]$ by su* report1 su* recomm5dations z ! ,commission consid]s appropriate = ! improvem5t & enhancem5t ( su* aspect ( ! capital asset plann+ process4 7c7 ,p[]s ( commission 7#a7 ,he>+s ,! ,commission may hold su* he>+s1 sit & act at su* times & places1 take su* te/imony1 & receive su* evid5ce z ! ,commission consid]s advisable to c>ry out ?is section4 7#b7 ,in=mation f ,f$]al ag5cies ,! ,commission may secure directly f any ,f$]al dep>tm5t or ag5cy su* in=mation z ! ,commission consid]s necess>y to c>ry out ?is section4 ,^u reque/ ( ! ,*air ( ! ,commission1 ! head ( su* dep>tm5t or ag5cy %all furni% su* in=mation to ! ,commission4 7d7 ,commission p]sonnel matt]s 7#a7 ,comp5sation ( memb]s ,ea* memb] ( ! ,commission :o is n an (fic] or employee ( ! ,f$]al ,gov]nm5t %all be comp5sat$ at a rate equal to ! daily equival5t ( ! annual rate ( basic pay prescrib$ = level ,,iv ( ! ,executive ,s*$ule "u section #ecae ( title #e1 ,unit$ ,/ates ,code1 = ea* day 7includ+ travel "t7 dur+ :i* su* memb] is engag$ 9 ! p]=mance ( ! duties ( ! ,commission4 ,all memb]s ( ! ,commission :o are (fic]s or employees ( ! ,unit$ ,/ates %all s]ve )\t comp5sation 9 addition to t receiv$ = _! s]vices z (fic]s or employees ( ! ,unit$ ,/ates4 7#b7 ,travel exp5ses ,! memb]s ( ! ,commission %all be all[$ travel exp5ses1 includ+ p] diem 9 lieu ( subsi/5ce1 at rates au?oriz$ = employees ( ag5cies "u sub*apt] ,i ( *apt] #eg ( title #e1 ,unit$ ,/ates ,code1 :ile away f _! homes or regul> places ( bus9ess 9 ! p]=mance ( s]vices = ! ,commission4 7#c7 ,/aff 7,a7 ,9 g5]al ,! ,*air ( ! ,commission may1 )\t reg>d to ! civil s]vice laws & regulations1 appo9t & t]m9ate an executive director & su* o!r additional p]sonnel z may be necess>y to enable ! ,commission to p]=m its duties4 ,! employm5t ( an executive director %all be subject to confirmation by ! ,commission4 7,b7 ,comp5sation ,! ,*air ( ! ,commission may fix ! comp5sation ( ! executive director & o!r p]sonnel )\t reg>d to *apt] #ea & sub*apt] ,,iii ( *apt] #ec ( title #e1 ,unit$ ,/ates ,code1 relat+ to classification ( positions & ,g5]al ,s*$ule pay rates1 except t ! rate ( pay = ! executive director & o!r p]sonnel may n exce$ ! rate payable = level ,v ( ! ,executive ,s*$ule "u section #ecaf ( su* title4 7#d7 ,detail ( gov]nm5t employees ,any ,f$]al ,gov]nm5t employee may be detail$ to ! ,commission )\t reimbursem5t1 & su* detail %all be )\t int]ruption or loss ( civil s]vice /atus or privilege4 7#e7 ,procurem5t ( tempor>y & int]mitt5t s]vices ,! ,*air ( ! ,commission may procure tempor>y & int]mitt5t s]vices "u section #caji7;b7 ( title #e1 ,unit$ ,/ates ,code1 at rates = individuals :i* d n exce$ ! daily equival5t ( ! annual rate ( basic pay prescrib$ = level ,v ( ! ,executive ,s*$ule "u section #ecaf ( su* title4 7e7 ,t]m9ation ( commission ,! ,commission %all t]m9ate #fj days aft] ! date on :i* ! ,commission submits its report "u subsection 7b77#d77;,e74 7f7 ,fund+ ,! ,secret>y ( ,vet]ans ,affairs %all make available to ! ,commission su* am\nts z ! ,secret>y & ! ,*air ( ! ,commission jo9tly consid] appropriate = ! ,commission to p]=m its duties "u ?is section4 7g7 ,action on recomm5dations 7#a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all implem5t ea* recomm5dation includ$ 9 a report "u subsection 7b77#d7 t ! ,secret>y consid]s feasible & advisable & c be implem5t$ )\t fur!r legislative action4 7#b7 ,reports ,n lat] ?an #abj days aft] receipt ( a report "u subp>agraphs 7,a7 ?r\gh 7,d7 ( subsection 7b77#d71 ! ,secret>y %all submit to ! ,committee ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report sett+ =? ! foll[+3 7,a7 ,an assessm5t ( ! feasibility & advisability ( ea* recomm5dation conta9$ 9 su* report4 7,b7 ,= ea* recomm5dation assess$ z feasible & advisable-- 7i7 if su* recomm5dation does n require fur!r legislative action = implem5tation1 a description ( ! actions tak51 & to be tak51 by ! ,secret>y to implem5t su* recomm5dation2 & 7ii7 if su* recomm5dation requires fur!r legislative action = implem5tation1 recomm5dations = su* legislative action4 #djd4 ,removal ( ,s5ior ,executive ,s]vice employees ( ! ,dep>tm5t ( ,vet]ans ,affairs = p]=mance 7a7 ,removal or transf] 7#a7 ,9 g5]al ,*apt] #g ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+ new section3 #gac4 ,s5ior ,executive ,s]vice3 removal bas$ on p]=mance 7a7 ,9 g5]al ,! ,secret>y may remove any individual f ! ,s5ior ,executive ,s]vice if ! ,secret>y det]m9es ! p]=mance ( ! individual w>rants su* removal4 ,if ! ,secret>y s removes su* an individual1 ! ,secret>y may-- 7#a7 remove ! individual f ! civil s]vice 7z def9$ 9 section #baja ( title #e72 or 7#b7 transf] ! individual to a ,g5]al ,s*$ule position at any grade ( ! ,g5]al ,s*$ule = :i* ! individual is qualifi$ & t ! ,secret>y det]m9es is appropriate4 7b7 ,notice to ,congress ,n lat] ?an #cj days aft] remov+ or transf]r+ an individual f ! ,s5ior ,executive ,s]vice "u p>agraph 7#a71 ! ,secret>y %all submit to ! ,committees on ,vet]ans' ,affairs ( ! ,s5ate & ,h\se ( ,repres5tatives notice 9 writ+ ( su* removal or transf] & ! reason = su* removal or transf]4 7c7 ,appeal ( removal or transf] ,any removal or transf] "u subsection 7a7 may be appeal$ to ! ,m]it ,sy/ems ,protection ,bo>d "u section #ggja ( title #e n lat] ?an #g days aft] su* removal or transf]4 7d7 ,exp$it$ review by ,m]it ,sy/ems ,protection ,bo>d 7#a7 ,! ,m]it ,sy/ems ,protection ,bo>d %all exp$ite any appeal "u section #ggja ( title #e ( a removal or transf] "u subsection 7a7 &1 9 any su* case1 %all issue a decision n lat] ?an #ba days aft] ! date ( ! appeal4 7#b7 ,9 any case 9 :i* ! ,m]it ,sy/ems ,protection ,bo>d det]m9es t x _c issue a decision 9 accordance ) ! #ba-;day requirem5t "u p>agraph 7#a71 ! ,m]it ,sy/ems ,protection ,bo>d %all submit to ,congress a report t expla9s ! reason :y ! ,m]it ,sy/ems ,protection ,bo>d is unable to issue a decision 9 accordance ) su* requirem5t 9 su* case4 7#c7 ,!re is au?oriz$ to be appropriat$ su* sums z may be necess>y = ! ,m]it ,sy/ems ,protection ,bo>d to exp$ite appeals "u p>agraph 7#a74 7#d7 ,! ,m]it ,sy/ems ,protection ,bo>d may n /ay any p]sonnel action tak5 "u ?is section4 4 7#b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( su* *apt] is am5d$ by add+ at ! end ! foll[+ new item3 #gac4 ,s5ior ,executive ,s]vice3 removal bas$ on p]=mance4 4 7b7 ,e/abli%m5t ( exp$it$ review process 7#a7 ,9 g5]al ,n lat] ?an #cj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,m]it ,sy/ems ,protection ,bo>d %all e/abli% & put into effect a process to conduct exp$it$ reviews 9 accordance ) section #gac7;d7 ( title #ch1 ,unit$ ,/ates ,code4 7#b7 ,inapplicability ( c]ta9 regulations ,section #abja4bb ( title #e1 ,code ( ,f$]al ,regulations1 z 9 effect on ! day be=e ! date ( ! enactm5t ( ?is ,act1 %all n apply to exp$it$ reviews c>ri$ out "u section #gac7;d7 ( title #ch1 ,unit$ ,/ates ,code4 7#c7 ,report by ,m]it ,sy/ems ,protection ,bo>d ,n lat] ?an #cj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,m]it ,sy/ems ,protection ,bo>d %all submit to ,congress a report on ! actions ! ,bo>d plans to take to conduct exp$it$ reviews "u section #gac7;d7 ( title #ch1 ,unit$ ,/ates ,code1 z add$ by subsection 7a74 ,su* report %all include a description ( ! res\rces ! ,bo>d det]m9es w be necess>y to conduct su* reviews & a description ( :e!r any res\rces w be necess>y to conduct su* reviews t 7 n available to ! ,bo>d on ! day be=e ! date ( ! enactm5t ( ?is ,act4 7c7 ,tempor>y exemption f c]ta9 limitation on initiation ( removal f ,s5ior ,executive ,s]vice ,dur+ ! #abj-;day p]iod beg9n+ on ! date ( ! enactm5t ( ?is ,act1 an action to remove an individual f ! ,s5ior ,executive ,s]vice at ! ,dep>tm5t ( ,vet]ans ,affairs pursuant to section #gac ( title #ch1 ,unit$ ,/ates ,code1 z add$ by subsection 7a71 or section #gedc ( title #e1 ,unit$ ,/ates ,code1 may be initiat$1 not)/&+ section #ceib7;b7 ( title #e1 ,unit$ ,/ates ,code1 or any o!r provision ( law4 7d7 ,con/ruction ,no?+ 9 ?is section or section #gac ( title #ch1 ,unit$ ,/ates ,code1 z add$ by subsection 7a71 %all be con/ru$ to apply to an appeal ( a removal1 transf]1 or o!r p]sonnel action t 0 p5d+ be=e ! date ( ! enactm5t ( ?is ,act4 ,v ,major ,m$ical ,facility ,leases #eja4 ,au?orization ( major m$ical facility leases ,! ,secret>y ( ,vet]ans ,affairs may c>ry out ! foll[+ major m$ical facility leases at ! locations specifi$1 & 9 an am\nt = ea* lease n to exce$ ! am\nt %[n = su* location 7n includ+ any e/imat$ cancellation co/s73 7#a7 ,= a cl9ical rese>* & ph>macy coord9at+ c5t]1 ,albuqu]que1 ,new ,mexico1 an am\nt n to exce$ #i1efj1jjj4 7#b7 ,= a community-bas$ outpati5t cl9ic1 ,brick1 ,new ,j]sey1 an am\nt n to exce$ #g1bhj1jjj4 7#c7 ,= a new prim>y c>e & d5tal cl9ic annex1 ,*>le/on1 ,s\? ,c>ol9a1 an am\nt n to exce$ #g1jgj1bej4 7#d7 ,= ! ,cobb ,c\nty community-bas$ ,outpati5t ,cl9ic1 ,cobb ,c\nty1 ,georgia1 an am\nt n to exce$ #f1dji1jjj4 7#e7 ,= ! ,leew>d ,outpati5t ,heal?c>e ,access ,c5t]1 ,honolulu1 ,hawaii1 includ+ a co-locat$ cl9ic ) ! ,dep>tm5t ( ,def5se & ! co-location ( ! ,honolulu ,regional ,(fice ( ! ,vet]ans ,b5efits ,adm9i/ration & ! ,kapolei ,vet ,c5t] ( ! ,dep>tm5t ( ,vet]ans ,affairs1 an am\nt n to exce$ #ae1hhg1cgj4 7#f7 ,= a community-bas$ outpati5t cl9ic1 ,johnson ,c\nty1 ,kansas1 an am\nt n to exce$ #b1bfc1jjj4 7#g7 ,= a replacem5t community-bas$ outpati5t cl9ic1 ,lafayette1 ,l\isiana1 an am\nt n to exce$ #b1iif1jjj4 7#h7 ,= a community-bas$ outpati5t cl9ic1 ,lake ,*>les1 ,l\isiana1 an am\nt n to exce$ #b1fbf1jjj4 7#i7 ,= outpati5t cl9ic consolidation1 ,new ,port ,ri*ey1 ,florida1 an am\nt n to exce$ #aa1ibg1jjj4 7#aj7 ,= an outpati5t cl9ic1 ,ponce1 ,pu]to ,rico1 an am\nt n to exce$ #aa1ece1jjj4 7#aa7 ,= lease consolidation1 ,san ,antonio1 ,texas1 an am\nt n to exce$ #ai1dbf1jjj4 7#ab7 ,= a community-bas$ outpati5t cl9ic1 ,san ,diego1 ,cali=nia1 an am\nt n to exce$ #aa1idf1ajj4 7#ac7 ,= an outpati5t cl9ic1 ,tyl]1 ,texas1 an am\nt n to exce$ #d1cbg1jjj4 7#ad7 ,= ! ,err]a ,community ,c>e ,c5t]1 ,we/ ,hav51 ,connecticut1 an am\nt n to exce$ #d1hhc1jjj4 7#ae7 ,= ! ,worce/] community-bas$ ,outpati5t ,cl9ic1 ,worce/]1 ,massa*usetts1 an am\nt n to exce$ #d1hee1jjj4 7#af7 ,= ! expansion ( a community-bas$ outpati5t cl9ic1 ,cape ,gir>deau1 ,miss\ri1 an am\nt n to exce$ #d1bcb1jfj4 7#ag7 ,= a multispecialty cl9ic1 ,*attanooga1 ,t5nessee1 an am\nt n to exce$ #g1jfi1jjj4 7#ah7 ,= ! expansion ( a community-bas$ outpati5t cl9ic1 ,*ico1 ,cali=nia1 an am\nt n to exce$ #d1ecd1jjj4 7#ai7 ,= a community-bas$ outpati5t cl9ic1 ,*ula ,vi/a1 ,cali=nia1 an am\nt n to exce$ #c1gad1jjj4 7#bj7 ,= a new rese>* lease1 ,h9es1 ,ill9ois1 an am\nt n to exce$ #bb1jcb1jjj4 7#ba7 ,= a replacem5t rese>* lease1 ,h\/on1 ,texas1 an am\nt n to exce$ #f1adb1jjj4 7#bb7 ,= a community-bas$ outpati5t cl9ic1 ,l9coln1 ,nebraska1 an am\nt n to exce$ #g1agh1djj4 7#bc7 ,= a community-bas$ outpati5t cl9ic1 ,lubbock1 ,texas1 an am\nt n to exce$ #h1eed1jjj4 7#bd7 ,= a community-bas$ outpati5t cl9ic consolidation1 ,myrtle ,bea*1 ,s\? ,c>ol9a1 an am\nt n to exce$ #h1jbb1jjj4 7#be7 ,= a community-bas$ outpati5t cl9ic1 ,pho5ix1 ,arizona1 an am\nt n to exce$ #bj1geg1jjj4 7#bf7 ,= ! expansion ( a community-bas$ outpati5t cl9ic1 ,r$d+1 ,cali=nia1 an am\nt n to exce$ #h1aed1jjj4 7#bg7 ,= ! expansion ( a community-bas$ outpati5t cl9ic1 ,tulsa1 ,oklahoma1 an am\nt n to exce$ #ac1bfi1bjj4 #ejb4 ,budget>y treatm5t ( ,dep>tm5t ( ,vet]ans ,affairs major m$ical facilities leases 7a7 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,title #ca1 ,unit$ ,/ates ,code1 requires ! ,dep>tm5t ( ,vet]ans ,affairs to record ! full co/ ( its contractual obligation aga9/ funds available at ! "t a contract is execut$4 7#b7 ,(fice ( ,managem5t & ,budget ,circul> ,a-#aa provides guidance to ag5cies 9 meet+ ! /atutory requirem5ts "u title #ca1 ,unit$ ,/ates ,code1 ) respect to leases4 7#c7 ,= op]at+ leases1 ,(fice ( ,managem5t & ,budget ,circul> ,a-#aa requires ! ,dep>tm5t ( ,vet]ans ,affairs to record up-front budget au?ority 9 an am\nt equal to total paym5ts "u ! full t]m ( ! lease or an am\nt suffici5t to cov] fir/ ye> lease paym5ts plus cancellation co/s4 7b7 ,requirem5t = obligation ( full co/ 7#a7 ,9 g5]al ,subject to ! availability ( appropriations provid$ 9 advance1 9 ex]cis+ ! au?ority ( ! ,secret>y ( ,vet]ans ,affairs to ent] into leases provid$ 9 ?is ,act1 ! ,secret>y %all record1 pursuant to section #aeja ( title #ca1 ,unit$ ,/ates ,code1 z ! full co/ ( ! contractual obligation at ! "t a contract is execut$ ei!r-- 7,a7 an am\nt equal to total paym5ts "u ! full t]m ( ! lease2 or 7,b7 if ! lease specifies paym5ts to be made 9 ! ev5t ! lease is t]m9at$ be=e its full t]m1 an am\nt suffici5t to cov] ! fir/ ye> lease paym5ts plus ! specifi$ cancellation co/s4 7#b7 ,self-insur+ au?ority ,! requirem5ts ( p>agraph 7#a7 may be satisfi$ ?r\gh ! use ( a self-insur+ au?ority consi/5t ) ,(fice ( ,managem5t & ,budget ,circul> ,a-#aa4 7c7 ,transp>5cy 7#a7 ,compliance ,subsection 7b7 ( section #hajd ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#g7 ,9 ! case ( a prospectus propos+ fund+ = a major m$ical facility lease1 a detail$ analysis ( h[ ! lease is expect$ to comply ) ,(fice ( ,managem5t & ,budget ,circul> ,a-#aa & section #acda ( title #ca 7commonly ref]r$ to z ! ,anti-,defici5cy ,act74 ,any su* analysis %all include-- 7,a7 an analysis ( ! classification ( ! lease z a lease-pur*ase1 capital lease1 or op]at+ lease z ^? t]ms are def9$ 9 ,(fice ( ,managem5t & ,budget ,circul> ,a-#aa2 7,b7 an analysis ( ! obligation ( budget>y res\rces associat$ ) ! lease2 & 7,c7 an analysis ( ! me?odology us$ 9 det]m9+ ! asset co/1 fair m>ket value1 & cancellation co/s ( ! lease4 4 7#b7 ,submittal to ,congress ,su* section #hajd is fur!r am5d$ by add+ at ! end ! foll[+ new subsection3 7h7 7#a7 ,n less ?an #cj days be=e ent]+ into a major m$ical facility lease1 ! ,secret>y %all submit to ! ,committees on ,vet]ans' ,affairs ( ! ,s5ate & ! ,h\se ( ,repres5tatives-- 7,a7 notice ( ! ,secret>y's int5tion to ent] into ! lease2 7,b7 a detail$ summ>y ( ! propos$ lease2 7,c7 a description & analysis ( any diff]5ces betwe5 ! prospectus submitt$ pursuant to subsection 7b7 & ! propos$ lease2 & 7,d7 a scor+ analysis demon/rat+ t ! propos$ lease fully complies ) ,(fice ( ,managem5t & ,budget ,circul> ,a-#aa4 7#b7 ,ea* committee describ$ 9 p>agraph 7#a7 %all ensure t any in=mation submitt$ to ! committee "u su* p>agraph is treat$ by ! committee ) ! same level ( confid5tiality z is requir$ by law ( ! ,secret>y & subject to ! same /atutory p5alties = unau?oriz$ disclosure or use z ! ,secret>y4 7#c7 ,n m ?an #cj days aft] ent]+ into a major m$ical facility lease1 ! ,secret>y %all submit to ea* committee describ$ 9 p>agraph 7#a7 a report on any mat]ial diff]5ces betwe5 ! lease t 0 ent]$ into & ! propos$ lease describ$ "u su* p>agraph1 includ+ h[ ! lease t 0 ent]$ into *anges ! previ\sly submitt$ scor+ analysis describ$ 9 subp>agraph 7,d7 ( su* p>agraph4 4 7d7 ,rule ( con/ruction ,no?+ 9 ?is section1 or ! am5dm5ts made by ?is section1 %all be con/ru$ to 9 any way relieve ! ,dep>tm5t ( ,vet]ans ,affairs f any /atutory or regulatory obligations or requirem5ts exi/+ prior to ! enactm5t ( ?is section & su* am5dm5ts4 ,june #d1 #bjad,read ! second "t & plac$ on ! cal5d>